Secure Loan Application Form

COGIC Credit Union

701 E Pinhook St., Lafayette LA 70501
Phone: (337-372-1700) | Fax: (877-471-5646)
Type of Loan Applying For

Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:

1. You live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI),
2. Your spouse will use the account, or
3. You are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about the person on whose payments you are relying.

Joint Credit: Each Applicant must individually complete the appropriate section below, If Co-Borrower is spouse of the Applicant,- mark the Co-Applicant box.

Check below to indicate the type of credit for which you are applying.

This credit union may offer Life / Disability, GAP or Warranty Insurance, but none is required to obtain credit. If you notify the credit union that you are interested, the credit union will disclose the cost of the voluntary coverage to you. You must sign a separate election disclosing the terms and conditions for any coverage to become effective.

  Account / Loan:
Payment Protection Coverage
Check coverage(s) desired. The Credit Union will disclose the cost of this voluntary insurance to you. A separate enrolment form which discloses the terms and conditions must be signed for coverage to become effective.
Applicant Information
Current Account Holder
US Citizen
Current Account Holder
US Citizen
Employment Information
If at current employer less than 2 years, enter previous
If at current employer less than 2 years, enter previous
NOTE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for this credit request.
Debts & Assets (Mortgage or Rent)
Mortgage or Rent Payments
References (Nearest relative not living with you)
What is their home address?
What is their home address?
Extra Comments
Submit Application
I/we certify that this information on all pages had been supplied truthfully, accurately and voluntarily, and therefore authorize this credit union to investigate our creditworthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means for consideration for the loan applied for herein, or for any other service offered by this credit union or its affiliate. The credit union may release information about its credit experience with me/us as permitted by law. If this application is for the purpose of encumbering real property, I/we agree to pay all allowable expenses incurred in processing this application whether or not the loan is approved. This application does not constitute a contract for the extension of credit. I/we understand that it may be a Federal Crime punishable by fine or imprisonment or both knowingly make any false statements concerning any of the above facts, as applicable under the provisions of Title 18, United States Code, Section 1014.