Secure Loan Application

Loan Information

Loan Type

Loan Purpose

Requested Amount ($)

I have read and agree with the Credit Card Terms and Conditions

Applicant Information

First Name

Last Name

Non-Member

Member #

Social Security #

Date of Birth

Marital Status

Email Address

Phone Number

Driver's License

Applicant's Present Address

Street Address

City

State

Zip Code

Years at this address

Housing Status

Monthly Housing Expense

Applicant's Previous Address

Complete if present address is less than 3 yrs.

Street Address

City

State

Zip Code

From

To

Applicant's Employment Information

Applicant's Present Employer

Present Employer

Occupation

Street Address

City

State

Zip Code

Employer Phone #

Employment Start Date

Gross Monthly Income for the Employer Above

Whole Dollars. If you would like us to include other sources of income, please discuss this with our Loan Officers. Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.

Applicant's Previous Employer

Complete if current employment is less than 2 years.

Previous Employer

Occupation

Street Address

City

State

Zip Code

Employer Phone #

Employment Start Date

Employment End Date

Applicant's Other Income

Part-Time Income / 2nd Income per Month

Applicant Personal References

Please provide two references.

First and Last Name

Relationship To You

Phone Number

First and Last Name

Relationship To You

Phone Number

Is there a joint applicant?

No Yes

Joint Applicant Information

First Name

Last Name

Non-Member

Member #

Social Security #

Date of Birth

Marital Status

Email Address

Phone Number

Driver's License

Joint Applicant's Present Address

Street Address

City

State

Zip Code

Years at this address

Housing Status

Monthly Housing Expense

Joint Applicant's Previous Address

Complete if present address is less than 3 yrs.

Street Address

City

State

Zip Code

From

To

Joint Applicant's Employment Information

Joint Applicant's Present Employer

Present Employer

Occupation

Street Address

City

State

Zip Code

Employer Phone #

Employment Start Date

Gross Monthly Income for the Employer Above

Whole Dollars. If you would like us to include other sources of income, please discuss this with our Loan Officers. Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.

Joint Applicant's Previous Employer

Complete if current employment is less than 2 years.

Previous Employer

Occupation

Street Address

City

State

Zip Code

Employer Phone #

Employment Start Date

Employment End Date

Joint Applicant's Other Income

Part-Time Income / 2nd Income per Month

Joint Applicant Personal References

Please provide two references.

First and Last Name

Relationship To You

Phone Number

First and Last Name

Relationship To You

Phone Number

Payment Protection

Payment Protection* Preserve your financial future. Payment protection coverages provide a valuable safety net by making loan payments in the event of disability or death of a covered member. Your election of the coverages offered below is only a statement of intent. Payment protection options and enrollment will be finalized by the credit union.

Yes – Provide Term Life and Disability Coverage* Yes – Provide Disability Coverage only* Yes – Provide Term Life only* Yes – Provide GAP (Guaranteed Asset Protection)* No – Not at this time*

How do you prefer to be contacted?

Phone Text Email

Comments

Enter Comments Here

READ CAREFULLY BEFORE SIGNING/SUBMITTING. PER YOUR MEMBERSHIP AGREEMENT AND /OR LOAN AGREEMENTS WITH THE FCCCU YOU GIVE US A SECURITY INTEREST IN YOUR ACCOUNT(S) AND CERTAIN OTHER PROPERTY PLEDGED AS DESCRIBED IN SAID AGREEMENTS.

You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. If there are any important changes you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, renewal or extension of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. 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. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.

I have read this section and agree to the terms.