Loan Application

This form will NOT be sent electronically, due to the insecurity of the Internet without a secure line. Fill it out by typing in what's in the form, and print it out. Then mail it to our office or stop by and drop it off.

TYPE AND AMOUNT OF CREDIT YOU'RE REQUESTING

Is this your first loan from us?	yes no
Amount/Credit Limit Requested:	$
Approximate Time to Repay:	How Many? Periods:
Loan Type:
Security Offered:	(for secured credit only)
Type of Credit:	Individual Joint

PAYMENT PROTECTION COVERAGE Check if desired

Check coverage(s) desired. The credit union will disclose the cost of this Payment Protection Coverage to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.

Yes No	Do you want your loan protected for you and your family if you become disabled?
Yes No	Do you want your loan protected for you and your family in the event of your death?

TELL US ABOUT YOURSELF

Applicant	Co-Applicant
Name:	Name:
CU Account #:	CU Account #:
Social Security #:	Social Security #:
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state: Married Separated Unmarried (Single - Divorced - Widowed)	Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state: Married Separated Unmarried (Single - Divorced - Widowed)

DEBTS	DEBTS
Mortgage/Rent owed to:	Mortgage/Rent owed to:
Balance (Mortgage only):	Balance (Mortgage only):
Monthly Payment: Current APR % (Mortgage only):	Monthly Payment: Current APR % (Mortgage only):
Person Responsible for Payment:	Person Responsible for Payment:
INCOME	INCOME
Employer:	Employer:
Income: $ Net Gross Annual Monthly Bi-weekly Weekly	Income: $ Net Gross Annual Monthly Bi-weekly Weekly
Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.) Source: $ Annual MonthlyHourly	Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.) Source: $ Annual MonthlyHourly

NOTICE TO WISCONSIN RESIDENTS: No provision of any marital property agreement, unilateral statement under S.766.59, or court decree under S.766.70 will adversely affect the rights of the credit union unless the credit union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened.

If you are applying for this account or loan with someone other than your spouse, you agree by signing below that the credit applied for, if granted, will be incurred in the interest of the marriage or family.

____________________
Borrower Signature and Date

SIGNATURES: You promise that everything you have stated in this request is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You also agree to notify us of any change in your name, address or employment within a reasonable time thereafter. You authorize the credit union to obtain credit reports in connection with this request. If you request, the credit union will tell you the name and address of any credit bureau from which it received a credit report on you. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on requests made to Federal Credit Unions or State Chartered Credit Unions insured by the NCUA. You understand that the credit union will rely on the information in the request and your credit report to make its decision.

X___________________________
Applicant Signature and Date

X___________________________
Co-Applicant Signature and Date

By submitting this loan request, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment.

You authorize the credit union to obtain credit reports in connection with this request.

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