Secure Loan Application Form

2433 Fort Street, Golden CO 80401
Phone: 303-278-4636 | Fax: (303) 278-4680

Type Of Loan Applying For
Individual Credit: You must complete the Applicant section about yourself and the Joint Applicant 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 Joint Applicant 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.
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.

Email Address

Loan: Individual Joint

Amount Requested: $.00             Purpose / Collateral:

Repayment: Payroll Deduction Cash Military Allotment Automatic Payment





Applicant Information
Applicant's Name:
Account #:
Driver License #:
Social Security #:
US Citizen: Yes No
Birthdate:
Marital Status:
Home Phone #:
Mobile Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
If less than 2 years enter previous address:
Spouse Other
Joint Applicant's Name:
Account #:
Driver License #:
Social Security #:
US Citizen: Yes No
Birthdate:
Marital Status:
Home Phone #:
Mobile Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
If less than 2 years enter previous address:


Employment Information
Applicant Employer's Name:
Employer Phone #:
Employer Address:
Department:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
Joint App. Employer's Name:
Employer Phone #:
Employer Address:
Department:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Complete if current employment is less than 2 years:
Previous Employers 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.



Debts & Assets (Mortgage or Rent)
Lender
Party
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
Child Support Payments / Alimony $
Have you ever filed for bankruptcy or had debt adjustment under Chapter 13?
   Are you a party in a lawsuit?
   Have you ever had property foreclosed or repossesion in the last 7 years?
Are you co-maker/endorser on any loan not listed above?
   If yes then for whom?
   If yes then to whom?
Are you a U.S. citizen or permanent resident alien?


References (Nearest relative not living with you)
First Name: Middle Name: Last Name: Suffix:
  Home Phone Number:
   555-555-5555
  What is their home address?
Street: City: State: Zip:
  What is the relationship?

References
First Name: Middle Name: Last Name: Suffix:
  Home Phone Number:
   555-555-5555
  What is their home address?
Street: City: State: Zip:
  What is the relationship?



Extra Comments

Submit Application

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.

     

Copyright 2015 Jeffco Federal Credit Union