CHECK TYPE OF CREDIT REQUESTED
Individual Credit: Complete sections A, B, D, E and F if only the applicant's income is considered for loan approval. Complete sections A, B, C, D, E and F (1) If you are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of credit requested, or; (2) if you reside in a community Property State or; (3) if you are relying on property located in a Community Property State as a basis for repayment of the credit requested Community Property Sates include: AZ, CA, ID, LA, NM, NV, TX, WA and WI.
Joint Credit: Complete sections A, B, C, D, E and F if your co-applicant will be contractually liable for repayment of the loan.
I/We would like a loan of:  $
For the following purpose: 

Security offered: 
Account number: 
A. Applicant's Personal Information
Check one if you reside in or are relying on property in a community property state or if you are applying for other than individual unsecured credit
Married Unmarried Separated
Full name:  
Last: First:
Date of birth:  
Social security no.:  
Present address:  
Street:
City:
State: Zipcode:
How long at present address?  
Home phone number:  
Area Code: Number:
Work phone number:  
Area Code: Number:
Email address:  
Driver's license number and state:  
State:
Ages of dependents:  
Previous address
(if previous address less than two years):  
Street:
City:
State: Zipcode:
How long at previous address?  
B. Information Regarding Applicant
Present employer
Employer's address
Street:
City:
State: Zipcode:
Date employed
Occupation
Supervisor's name
Last: First:
Monthly take home pay $
Previous employer
Address
Street:
City:
State: Zipcode:
How long at previous employer?
Occupation
Real estate owned and address
(include home)
Street:
City:
State: Zipcode:
Date purchased
Purchase price $
Sources of other income
Amount of other income $
Total monthly income $
C. Information Regarding Spouse Former Spouse Co-Applicant
Full name
Last: First:
Date of birth
Driver's license no. and state State:
Social security number
Address
Street:
City:
State: Zipcode:
Home phone number
Area Code: Number:
Occupation
Monthly take home pay $
Present employer's name and address
Name:
Street:
City:
State: Zipcode:
Date employed
Work phone number
Area Code: Number:
Sources of other income
Amount of other income $
Total monthly income $
D. List All Existing Debts of Applicant (and Co-Applicant or Spouse if any part of section C is applicable)
Name and address of creditor Purpose or acct. # Original
amount		 Present
balance		 Monthly
payment
Home mortgage or landlord
 Renting
Buying		 $ $ $
Credit union
 $ $ $
Credit cards
1. 		$ $ $

2. 		$ $ $

3. 		$ $ $

4. 		$ $ $

5. 		$ $ $
Automobile loans
1. 		Automobile make, model and year
$ $
2. Automobile make, model and year
$ $
List alimony, child support or child care paid monthly
$
Do not omit any debts!
Incomplete applications cannot be processed.		 Total monthly
obligations
$
If you answer "yes" to any of these questions, provide additional details. Are any of your debts past due?
Yes No		 Have you ever had your auto, furniture or property repossessed?
Yes No
  If Yes: If Yes:
Have you or your co-applicant ever declared bankruptcy?
Yes No		 Are you currently a co-maker on a loan?
Yes No
If Yes: If Yes:
> E. Financial Information and References
Name of bank or other financial institution
Address
Street:
City:
State: Zipcode:
Type of accounts Checking Savings Loan
Name of relative not living with you
Address
Street:
City:
State: Zipcode:
Phone number
Area Code: Number:
Relationship
Name of personal reference not related to applicant
Last: First:
Address
Street:
City:
State: Zipcode:
Phone number
Area Code: Number:
F. Loan Protection Insurance
Indicate the coverage you desire. Your credit union will provide you with the cost of the coverage and an enrollment form that spells out the terms and conditions of this coverage. The enrollment form must be signed for coverage to become effective.
Yes, I am interested in loan protection designed to make my loan payment if I become disabled due to illness or injury. (statistics show that before reaching age 65, nearly one person in five will be disabled for five years or longer. *)
Yes, I am interested in loan protection designed to pay off my loan if I or the co-borrower dies (A significant percentage of people in the United States are underinsured, experts report. In fact, studies show that 40 percent of consumers have no life insurance at all. **)
The credit union will provide information about eligibility, including requirements, for the loan protection program.
* Life Association News, article reproduced on the Insurance News Network.
** Life Insurance Marketing and Research Association. MarketFacts, November/December 1996.
Master Application Authorization
Please read before submitting:
All the information in this application is true. I understand that section 1014 Title 18 U.S. Code makes it a federal crime to knowingly make a false statement on this application. You have my permission to check my information. You may retain this application even if not approved. By submitting this application, I understand that you may receive information from others about my credit and you may answer questions and requests from others seeking credit or experience information about me or my accounts with you. By submitting this application, I agree to honor the provisions of the credit or loan agreement and security agreement covering my account or loan if my loan is approved. (If this application is for two of us, this statement applies to both of us.)

For Home Equity Applications:
By submitting this application I agree to honor the provisions of the Home Equity Agreement and Truth in Lending Disclosure covering my loan if my loan is approved. By submitting this application, I understand that a copy of the Settlement Costs and Handbook will be mailed to me within 3 business days of the date that the credit union receives this application.
Have you omitted anything? Remember: Incomplete applications cannot be processed.
Additional Comments


©Copyright 1998, 1999 Minnesota Life Insurance Company. All Rights Reserved.

Back to Loan Guide line page