Upper Darby Bell Telco Federal Credit Union -- Secure Loan Application Form

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.

Individual Credit: You must complete the Applicant section about yourself.

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.

Email Address Term in Months Purpose

Amount Requested

Account / Loan:

Individual

Joint

Repayment:

Payroll Deduction Cash Military Allotment Automatic Payment

Year Make Model Mileage

Sales Price $

VIN #

Year Make Model VIN # Mileage

Sales Price $

Year Make Model VIN # Mileage

Sales Price $

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Options:

Leather Seats Sun Roof 4 Wheel Drive Navigation Rear Entertainment

Color of Vehicle: Other Options: Seller: Sales Person: Phone Number:

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 # Address Line 1 Address Line 2 (Apt/Unit #) 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 # Address Line 1 Address Line 2 (Apt/Unit #) City State Zip Current Address Since If less than 2 years, enter previous address

Employer Name Employer Phone # Employer Address Department Supervisor 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

Co-Applicant Employer Name Employer Phone # Employer Address Department Supervisor 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.

Enter your Debts and Assets

Lender Type Balance Payment

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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

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?

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

Full Name Suffix Home Phone #

What is their home address?

Street City State Zip

Relationship

Full Name Suffix Home Phone #

What is their home address?

Street City State Zip

Relationship

Notices

By submitting this form - I/We present this information truly and correctly as it is stated to the best of my/our knowledge for the purpose of obtaining credit from UDBell FCU. This information may be used to check credit and employement history as required from the credit union. By submitting you agree to the terms set forth and that UDBell FCU will be accessing your credit report as applicable.