Secure Loan Application Form

2832 Willowcreek Rd, Portage IN 46368
Phone: 219-763-5640 | Fax: (219) 703-5102


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.

Email Address

Account / Loan: Individual Joint Individual / Credit - Married Applicant (include spouse information)

Amount Requested: $             Term in Months:             Purpose:

Repayment: Payroll Deduction Cash Military Allotment Automatic Payment

Year Make Model VIN Number Mileage Sales Price
$
$
$

Options: Leather Seats Sun Roof 4 Wheel Drive Navigation Rear Entertainment

Seller:
Sales Person:
Phone Number:



Payment Protection Coverage
Check coverage(s) desired. The Credit Union will disclose the cost of this voluntary insurance to you. A separate enrollment 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 Information
Applicant's Name:
Account #:
Driver License #:
Social Security #:
US Citizen: Yes No
Birthdate:
Marital Status:
Home Phone #:
Mobile Phone #:
Street Address:
Street Address 2:
City: State:
Zip #:
Years at Current Address:
If less than 2 years enter previous address:
Joint Applicant's Name:
Account #:
Driver License #:
Social Security #:
US Citizen: Yes No
Birthdate:
Marital Status:
Home Phone #:
Mobile Phone #:
Street Address:
Street Address 2:
City: State:
Zip #:
Years at Current Address:
If less than 2 years enter previous address:


Employment Information
Applicant Employer's Name:
Employer Phone #:
Employer Address:
Supervisor:
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:
Supervisor:
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
Type
Balance
Payment
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Child Support Payments / Alimony $
Financial Information - please answer the following questions Applicant Co-Applicant
Have you ever 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?
   If yes to any of the above questions, please explain.


Reference (Relative only)
Full Name:
  Home Phone Number:
   555-555-5555
  What is their home address?
Street: City: State: Zip:

References (Friend Only)
Full Name:
  Home Phone Number:
   555-555-5555
  What is their home address?
Street: City: State: Zip:



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 2016 Midwest Family FCU