Mercy Credit Union -- Secure Loan Application Form

Married Applicants: May apply for a separate account.
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 Spouse Box. All others mark the Co-Applicant box unless you are a:
Guarantor - A guarantor has not interest in the collateral or benefits from the loan proceeds check the Guarantor box.

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 Number Term in Months Purpose

Amount Requested

Frequency

Repayment:

ACH Origination Coupon Book Auto Transfer

Co-Applicant Spouse Guarantor

Applicant's Name Email Social Security #

US Citizen

Yes No

Birthdate Home Phone # Mobile Phone # Address Line 1 Address Line 2 (Apt/Unit #) City State Zip Current Address Since Rent/Mortgage

Joint Name Email Social Security #

US Citizen

Yes No

Birthdate Home Phone # Phone # Address Line 1 Address Line 2 (Apt/Unit #) City State Zip Current Address Since Rent/Mortgage

Employer Name Position Date Hired(MM/DD/YY) Income ($) Applicant
Please mark to recieve correspondence via email

Co-Applicant Employer Name Position Date Hired(MM/DD/YY) Income ($) All Other Borrowers
Please mark to recieve correspondence via email

Drivers License #

Marital Status /span>

Employer Phone # Employer Address Department Supervisor Position Other Monthly Income ($) Drivers License #

Marital Status /span>

Employer Address Department Supervisor Position Other Monthly Income ($) Full Name Street Home Phone # Full Name Street Home Phone #

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.