Loan Forms

LOAN REQUEST

Tri County Credit Union

Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete
the Applicant section about yourself and the Co-Applicant section about your spouse if:

Your spouse will use the account, or
You are relying on your spouse's income as a basis for repayment.

If you feel you will need a Co-signer for this loan to be granted, please fill out the Co-applicant section. If you are applying for Joint Credit with another person, complete the Applicant and Co-Applicant sections.

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:	Periods:
Loan Type:
Security Offered:	(for secured credit only, not applicable to credit cards)
Type of Credit:	Individual Joint

PAYMENT PROTECTION COVERAGE Check if desired

We offer Payment Protection to those who qualify at additional cost. Payment Protection (which covers death or permanent disability) to a maximum of $25,000, is available to those who qualify.

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? Yes No

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)

Driver's License #: State:	Driver's License #: State:
Birth Date:	Birth Date:
Home Phone: Business Phone:	Home Phone: Business Phone:
Present Address: Years There: Own Rent	Present Address: Years There: Own Rent

Job Title:	Job Title:
ETS Date:	ETS Date:

DEBTS	DEBTS
Mortgage/Rent owed to:	Mortgage/Rent owed to:
Mortgage Balance: $	Mortgage Balance: $
Other Payments: $	Other Payments: $
Monthly Payment: $ Current APR % (Mortgage only): %	Monthly Payment: $ Current APR % (Mortgage only): %
Person Responsible for Payment:	Person Responsible for Payment:
Other Payments:	Other Payments:
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 Monthly Hourly	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 Monthly Hourly

This information is accurate as of May 1, 2000 and is subject to change after that date. Please contact the credit union for any changes to this information.

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 Tri County 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. By signing below, you agree to the terms of the Credit Card Agreement which will be sent with the card and you agree to pay all charges incurred in accordance with the terms of that Agreement.

X________________________________
Applicant Signature and Date

X________________________________
Co-Applicant Signature and Date

Please print, then fax this application to our office.

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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