APPLICATION FOR CREDIT

Please note: this credit union complies with the Equal Opportunity Act.
Application Date: _______________________ Amount Requested: _________________________________
Member Acct. No.: _____________________ Reason for Credit Request: ____________________________

Information on Borrower:
First Name: __________________________________ Middle: __________________ Last: _______________________________________
Birth Date: _______________________Social Security No.: __________________________Home Phone: _________________________
Cell Phone: _______________________ E-mail Address: ________________________________________________
Street Address: _____________________________________________ City: _______________________ State: _______ Zip: ____________
Employer's Name: ___________________________________________ Position: ___________________ Time at Job (years): ______
Employer's Phone: ___________________________
Gross Monthly Income: _______________________ Is there a co-applicant? Yes ____ No _____
Other Monthly Income: _______________________ Source of Other Monthly Income: _____________________
Are you a US citizen? Yes _____ No _____

Information on Co-Applicant:
First Name: __________________________________ Middle: __________________ Last: ______________________________________
Birth Date: _______________________Social Security No.: __________________________Home Phone: ________________________
Cell Phone: _______________________ E-mail Address: ________________________________________________
Street Address: _____________________________________________ City: ________________________ State: ______ Zip: ____________
Employer's Name: ___________________________________________ Position: ___________________ Time at Job (years): ______
Employer's Phone: ___________________________
Gross Monthly Income: _______________________
Other Monthly Income: _______________________ Source of Other Monthly Income: _____________________
Are you a US citizen? Yes _____ No _____

Nearest Relative Not Living With You:
Name: _______________________________________________________ Home Phone: ___________________________________
Street Address: _______________________________________________ City: ________________________ State: ______ Zip: __________
Relationship to applicant: ____________________________

Home: [ ]Own [ ] Buying [ ] Rent
Landlord or Mortgage Holder: _________________________________________
Value: ________________________ Balance: __________________________ Monthly Payment: ___________________

Automobiles:
Year/Model If financed, by whom Value Balance Payment
1._________________ _________________________ ____________________ ____________________ ____________________
2._________________ _________________________ ____________________ ____________________ ____________________

Debts: Include credit cards, child support, medical or other monthly installment payments.
Creditor Present Balance Monthly Payment
_________________________________ __________________________ __________________________
_________________________________ __________________________ __________________________
_________________________________ __________________________ __________________________

Declarations: In submitting this form, I/we certify that the above information is, to the best of our knowledge, true, complete and correct. I/we understand that I/we may lose our property (if this is a secured loan) if we do not make repayments as agreed on the loan document that may be executed in conjunction with this loan application. Indiana Lakes Federal Credit Union (ILFCU) may obtain verification from any source named in the application and from third parties as such as credit bureaus. ILFCU will retain the original copy of this application, even if the loan is denied or not closed for any reason. I/we authorize ILFCU to make credit investigations necessary to the judicious underwriting of the loan request and to answer valid requests regarding their credit experience with me/us. I/we also agree to update any information provided to ILFCU, and to inform ILFCU in writing of any material changes affecting our name, address, credit and employment. I/we fully understand that it is a federal crime, punishable by fine or imprisonment or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18 US C Sec. 1014. If this is an application of a joint account, these statements apply to all joint applicants.

Borrower Signature: ________________________________________________________ Date: _____________________________

Co-Borrower Signature: _____________________________________________________ Date: _____________________________

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