LoanLiner Application
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 (AZ, AX, IS, 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: If you are applying with another person, complete the Applicant and Other sections.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.
Check below to indicate the type of account(s) and type of credit for which you are applying. Married Applicants may apply for a separate account.
LOANLINER Account/Loan:

Individual Joint
(Including ATM/Debit Card Access to the Account if Available)

Amount Requested:

Purpose/Collateral:

Repayment:
 Payroll Deduction
Cash
Military Allotment
Automatic Payment
Payment
Protection

Single Credit Life Insurance

Joint Credit Life Insurance

Single Credit Disability Insurance

   Check Coverage(s) desired. The credit union will disclose the cost of this voluntary insurance to you. A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.
Applicant: Other: Co-Applicant Spouse Guarantor
Name (first,last,initial): Name (first,last,initial):
Mother's Maiden Name: Mother's Maiden Name:
Account Number: Account Number:
Social Security Number: Social Security Number:
Driver's License Number/State: Driver's License Number/State:
List Ages of Dependents Not Listed By Other Applicant (exclude self): List Ages of Dependents Not Listed By Other Applicant (exclude self):
Birth Date: Birth Date:
Home Phone: Home Phone:
Business Phone/Ext.: Business Phone/Ext.:
E-mail Address : E-mail Address :
Present Address (street, city, state, zip):

Years at this address:
Own Rent 		Present Address (street, city, state, zip):

Years at this address:
Own Rent
Previous Address (street, city, state, zip):

Years at this address:
Own Rent 		Previous Address (street, city, state, zip):

Years at this address:
Own Rent
Complete for joint credit, secured credit or if you live in a community property state:
Married Separated
Unmarried (single, divorced, widowed)		 Complete for joint credit, secured credit or if you live in a community property state:
Married Separated
Unmarried (single, divorced, widowed)
Employment/Income Employment/Income
Name of Employer: Name of Employer:
Address of Employer: Address of Employer:
Title/Grade: Title/Grade:
Start Date: Hours at Work: Start Date: Hours at Work:
Supervisor's Name: Supervisor's Name:
If self-employed, type of business: If self-employed, type of business:
Notice: Alimony, child support, or separate maintenance income need not be
revealed if you do not choose to have it considered.
Employment Income:
$ per
Net Gross 		Employment Income:
$ per
Net Gross
Other Income:
$ per
Net Gross
Other Income:
$ per
Net Gross
Military: Is duty station transfer expected during next year? Yes No
If yes, where?
Ending/Separation date: 		Military: Is duty station transfer expected during next year? Yes No
If yes, where?
Ending/Separation date:

If employed less than five years:
Name of Previous Employer:
Address of Previous Employer:

Start Date: End Date:

If employed less than five years:
Name of Previous Employer:
Address of Previous Employer:

Start Date: End Date:
Applicant Reference - Please provide the following information on the nearest relative not living with you: Other Reference - Please provide the following information on the nearest relative not living with you:
Name: Name:
Address: Address:
Relationship: Relationship:
Home Phone: Home Phone:
What You Owe
Rent
First Mortgage
(Include Tax & Ins.)		 Creditor Name Other Than This Credit Union:
Interest Rate: Present Balance:
Monthly Payment: Owed By: Applicant Other
2nd Mortgage Creditor Name Other Than This Credit Union:
Interest Rate: Present Balance:
Monthly Payment: Owed By: Applicant Other
1st Auto Loan Creditor Name Other Than This Credit Union:
Interest Rate: Present Balance:
Monthly Payment: Owed By: Applicant Other
2nd Auto Loan Creditor Name Other Than This Credit Union:
Interest Rate: Present Balance:
Monthly Payment: Owed By: Applicant Other
Child-Care Creditor Name Other Than This Credit Union:
Interest Rate: Present Balance:
Monthly Payment: Owed By: Applicant Other
Child Support Creditor Name Other Than This Credit Union:
Interest Rate: Present Balance:
Monthly Payment: Owed By: Applicant Other
Credit Card Creditor Name Other Than This Credit Union:
Interest Rate: Present Balance:
Monthly Payment: Owed By: Applicant Other
Credit Card Creditor Name Other Than This Credit Union:
Interest Rate: Present Balance:
Monthly Payment: Owed By: Applicant Other
Other Creditor Name Other Than This Credit Union:
Interest Rate: Present Balance:
Monthly Payment: Owed By: Applicant Other
Other Creditor Name Other Than This Credit Union:
Interest Rate: Present Balance:
Monthly Payment: Owed By: Applicant Other
List any names under which your credit references and credit history can be checked:
What You Own
Home List Location of Property or Financial Institution:

Market Value:
Pledged as collateral for another loan? Yes No
Owned by: Applicant Other
Auto List Location of Property or Financial Institution:

Market Value:
Pledged as collateral for another loan? Yes No
Owned by: Applicant Other
Savings List Location of Property or Financial Institution:

Market Value:
Pledged as collateral for another loan? Yes No
Owned by: Applicant Other
Checking List Location of Property or Financial Institution:

Market Value:
Pledged as collateral for another loan? Yes No
Owned by: Applicant Other
Other
Describe:
 List Location of Property or Financial Institution:

Market Value:
Pledged as collateral for another loan? Yes No
Owned by: Applicant Other
Other Information About You
If you answer "yes" to any question other than #1, explain in the box below.
Applicant
Other
1. Are you a U.S. Citizen or Permanent Resident Alien?
Yes No
Yes No

2. Do you currently have any outstanding judgments or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under Chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit?
Yes No
Yes No
3. Is your income likely to decline in the next two years?
Yes No
Yes No
4. Are you a co-maker, co-signer, or guarantor on any loan not listed above?
For Whom (name of others obligated on loan):

To Whom (name of creditor):
Yes No
Yes No
Miscellanous Comments:
State Law Notices

Ohio Residents Only: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.
Wisconsin Residents Only: (1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.
____________________________________________________________________
Signature for Wisconsin Residents Only

________________________________
Date

Signatures
1. You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. If there are any important changes you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension, or collection of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit union insured by NCUA.
________________________________
Applicant's Signature and Date		 _________________________________
Other Signature and Date