DuPage County Employees Credit Union -- Secure Loan Application Form

Secure Loan Application Form

DuPage County Employees Credit Union

421 County Farm Road, Wheaton IL 60187
Phone: 630-407-5270 | Fax: (630) 407-5271

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.

Single Credit Disability Joint Credit Disability None

Single Credit Life Insurance Joint Credit Life Insurance None

Applicant's Name

Current Account Holder

Yes No

Account # Drivers License # Social Security #

US Citizen

Yes No

Birthdate Marital Status Home Phone # Mobile Phone # Street Address City State Zip Current Address Since If less than 2 years, enter previous address

Joint Name

Current Account Holder

Yes No

Account # Drivers License # Social Security #

US Citizen

Yes No

Birthdate Marital Status Home Phone # Mobile Phone # Street Address City State Zip Current Address Since If less than 2 years, enter previous address

Employer Name Employer Phone # Employer Address Department Position Date Hired(MM/DD/YY) Monthly Gross Income ($) Other Monthly Income ($)

If at current employer less than 2 years, enter previous

Previous Employer Name Yrs Employed

Joint Employer Name Employer Phone # Employer Address Department Position Date Hired(MM/DD/YY) Monthly Gross Income ($) Other Monthly Income ($)

If at current employer less than 2 years, enter previous

Previous Employer Name Yrs Employed

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.

Mortgage or Rent Payments

Lender Type Balance Payment

++Show additional row

Child Support Payments / Alimony

Applicant

Have you filed for bankruptcy in the past 10 years? Do you have any outstanding judgements? Have you been obligated on any loan resulting in a repo, forclosure, or judgement? Are you obligated to pay alimony, child support, or separate maintenance? Are you co-maker, co-signer, or guarantor on any loan not listed above? Are you a U.S. citizen or permanent resident alien?

Co-Applicant

If yes to any of the above questions, please explain.

First Name Middle Name Last Name Suffix Home Phone #

What is their home address?

Street City State Zip

Relationship

First Name Middle Name Last Name Suffix Home Phone #

What is their home address?

Street City State Zip

Relationship

Notices

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.

DuPage County Employees Credit Union

421 County Farm Road, Wheaton IL 60187 Phone: 630-407-5270 | Fax: (630) 407-5271

421 County Farm Road, Wheaton IL 60187
Phone: 630-407-5270 | Fax: (630) 407-5271