Credit Application

Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information.nnThe items marked with (*) are required fields.

Will you be applying for Individual or Joint Credit?*
Marital Status: Complete marital status if this loan is for: a. Joint or secured credit, or b. You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)
Type of card Requested*
Limit Requested*
Number of Cards Requested*
Primary Applicant
Member Number*
First Name*
Last Name*
Middle Name
Social Security Number (TIN)*
Date of Birth*
MM slash DD slash YYYY
Number of Dependents*
Ages of Dependents*

(e.g. 12, 13, 20 etc.)
Home Phone*
Work Phone*
Cell Phone*
Email*
Driver's License Number*
Driver's License State*
Mother's Maiden Name*
Current Address
Home Address*
Street Address City State ZIP Code
Time at current residence*
Residence Type
Previous Address
Previous Address*
Street Address City State ZIP Code
Time at previous residence*
Previous Residence Type
Present Employer
Present Employer Name
Employer Phone
Employment Status
Job Title
Job Start Date
MM slash DD slash YYYY
Annual Salary
Other Income
Other Income Source

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Previous Employer
Previous Employer Name
Previous Employer Phone
Previous Job Start Date
MM slash DD slash YYYY
Previous Annual Salary
Other Income
Other Income Source

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Co-Applicant
Co-Applicant Member Number*
Co-Applicant First Name*
Co-Applicant Last Name*
Co-Applicant Middle Name
Co-Applicant Social Security Number (TIN)*
Co-Applicant Date of Birth*
MM slash DD slash YYYY
Co-Applicant Number of Dependents*
Co-Applicant Ages of Dependents*

(e.g. 12, 13, 20 etc.)
Co-Applicant Home Phone*
Co-Applicant Work Phone*
Co-Applicant Cell Phone*
Co-Applicant Email*
Co-Applicant Driver's License Number*
Co-Applicant Driver's License State*
Co-Applicant Mother's Maiden Name*
Co-Applicant Current Address
Co-Applicant Home Address*
Street Address City State ZIP Code
Co-Applicant Time at current residence*
Co-Applicant Residence Type
Co-Applicant Previous Address
Co-Applicant Previous Address*
Street Address City State ZIP Code
Co-Applicant Time at previous residence*
Co-Applicant Previous Residence Type
Co-Applicant Present Employer
Co-Applicant Present Employer Name
Co-Applicant Employer Phone
Co-Applicant Employment Status
Co-Applicant Job Title
Co-Applicant Job Start Date
MM slash DD slash YYYY
Co-Applicant Annual Salary
Co-Applicant Other Income
Co-Applicant Other Income Source

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Co-Applicant Previous Employer
Co-Applicant Previous Employer Name
Co-Applicant Previous Employer Phone
Co-Applicant Previous Job Title
Co-Applicant Previous Job Start Date
MM slash DD slash YYYY
Co-Applicant Previous Annual Salary
Co-Applicant Other Income
Co-Applicant Other Income Source

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Debts and Monthly Payments
List all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support, child care, medical, utilities, auto insurance, IRS liabilities, etc.) Please use a separate line for each credit card and auto loan.
Debts
Credit Card Monthly Payment

Use the plus sign to add more lines.
References
Nearest relative Not Living With You
Name
First Last
Relationship
Phone Number
Address
Street Address City State ZIP Code
How would you prefer to be contacted?
Special Instructions
Income verification is required; other information may be required. I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Financial Institution, information concerning me or my affairs.(Sec. 1014, Title 18, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.)

Primary Applicant

Current Address

Previous Address

Present Employer

Previous Employer

Co-Applicant

Co-Applicant Current Address

Co-Applicant Previous Address

Co-Applicant Present Employer

Co-Applicant Previous Employer

Debts and Monthly Payments

References

Our Contact Info

Credit Union Hours

Credit Card	Monthly Payment