Online Loan Application
MEMBER/BORROWER
First Name
Middle Initial
Last Name
Address
City
State
Zip Code

Home Phone

000-000-0000
Social Security No.
000-00-0000
Date of Birth
mm/dd/yyyy
Employer
Work Phone
000-000-0000
Date of Hire
mm/dd/yyyy
Hourly Wage
Monthly Gross Income
CO-BORROWER/CO-SIGNER
First Name
Middle Initial
Last Name
Address
City
State
Zip Code
Home Phone
000-000-0000
Social Security No.
000-00-0000
Date of Birth
mm/dd/yyyy
Employer
Work Phone
000-000-0000
Date of Hire
mm/dd/yyyy
Hourly Wage
Monthly Gross Income
OTHER INCOME

  Source     Amount

Total Monthly Income  
Amount Requested
Purpose
Collateral Description
Term of loan months
Marital status
Income from alimony/child or spousal support payments need not be revealed unless you want the credit union to consider them as a basis for repayment of debt.

Notice to Wisconsin Residents
No provision of a marital property agreement, a unilateral statement under Wis. Stat. SEc. 766.59 or a court decree under Wis. Stat. Sec. 766.70 adversely affects the interests of the credit union unless prior to the time the credit is extended, the credit union is furnished with a copy of the agreement, statement or decree, or has actual knowledge of the adverse provision when the obligation to the credit union is incurred.
Have you ever declared bankruptcy?NoYes
Year Reason
Monthly rent or mortgage amount Rent  Mortgage

Please note: Income verification and other information may be required.

I/We agree that, by submitting this application, I/we certify that the foregoing information has 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. If I/we am/are married, applying for individual credit, and living in a community property state, I/we certify that the credit being applied for, if granted, will be incurred in the interest of the marriage or family. If this statement applies, we are required by Wisconsin law to notify your spouse by mail if your loan is granted.


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