Express Application
Individual Credit: You must complete the Applicant section about yourself.
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.
Individual
LOANLINER Account/Loan:
Joint
(Including ATM/Debit Card Access to the Account if Available)
Amount Requested $
Purpose/Collateral:
Individual
Credit Card Account:
(See Agreement for Terms)
Credit Limit Requested $
If Authorized User, Name:
APPLICANT
OTHER:
NAME
NAME
CO-APPLICANT
Joint
SPOUSE
GUARANTOR
MEMBER NUMBER
SOCIAL SECURITY NUMBER
MEMBER NUMBER
SOCIAL SECURITY NUMBER
DRIVER'S LICENSE NUMBER/STATE
LIST AGES OF DEPENDENTS NOT LISTED BY
OTHER APPLICANT (Exclude Self)
DRIVER'S LICENSE NUMBER/STATE
LIST AGES OF DEPENDENTS NOT LISTED BY
OTHER APPLICANT (Exclude Self)
BIRTH DATE
HOME PHONE
BUSINESS PHONE/EXT.
BIRTH DATE
EMAIL ADDRESS
HOME PHONE
BUSINESS PHONE/EXT.
EMAIL ADDRESS
ARE YOU A U.S. CITIZEN?
YES
NO
ARE YOU A U.S. RESIDENT ALIEN?
PRESENT ADDRESS
OWN
YES
NO
ARE YOU A U.S. CITIZEN?
YES
NO
ARE YOU A U.S. RESIDENT ALIEN?
PRESENT ADDRESS
RENT
OWN
LENGTH AT RESIDENCE
PREVIOUS ADDRESS (If at present address less than 3 years)
OWN
LENGTH AT RESIDENCE
MORTGAGE
MORTGAGE
MORTGAGE BALANCE
$
$
IF YOU OWN YOUR OWN HOME, PLEASE COMPLETE:
SINGLE
MOBILE HOME
YEAR PURCHASED
RESIDENCE
AND LAND
CONDO
OWN
RENT
OWED TO:
MORTGAGE VALUE
RENT
MONTHLY PAYMENT
MORTGAGE BALANCE
MORTGAGE VALUE
$
$
$
$
PURCHASE PRICE
$
MOBILE HOME
RENT
LENGTH AT RESIDENCE
OWED TO:
RENT
MONTHLY PAYMENT
IF YOU OWN YOUR OWN HOME, PLEASE COMPLETE:
SINGLE
MOBILE HOME
YEAR PURCHASED
RESIDENCE
AND LAND
CONDO
PURCHASE PRICE
$
MOBILE HOME
EMPLOYMENT/INCOME
EMPLOYMENT/INCOME
NAME AND
ADDRESS OF
EMPLOYER
NAME AND
ADDRESS OF
EMPLOYER
TITLE
TITLE
STARTING DATE
YEARS IN PROFESSION
NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE
REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.
YEARS IN PROFESSION
STARTING DATE
NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE
REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.
GROSS EMPLOYMENT INCOME
OTHER INCOME
GROSS EMPLOYMENT INCOME
OTHER INCOME
$
$
$
$
PER
NO
LENGTH AT RESIDENCE
PREVIOUS ADDRESS (If at present address less than 3 years)
RENT
YES
PER
SOURCE
PER
PER
SOURCE
PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN THREE YEARS
PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN THREE YEARS
STARTING DATE
STARTING DATE
ENDING DATE
ENDING DATE
SIGNATURES
terms of the credit card agreement and disclosures. You grant us a
1. You promise that everything you have stated in this application is
security interest in all individual and joint share and/or deposit accounts
correct to the best of your knowledge. By signing below or making a
you have with us now and in the future to secure your credit card
verbal application, you authorize the Credit Union to obtain credit reports
account. When you are in default, you authorize us to apply the balance
or to verify information in connection with this application for credit and
in these accounts to any amounts due. Shares and deposits in an
for any update, increase, renewal, extensions, or collection of credit
Individual Retirement Account, and any other account that would lose
received.
special tax treatment under state or federal law if given as security, are
not subject to the security interest you have given in your shares and
2. If you are applying for a credit card, you understand that the use of
deposits.
your card will constitute acknowledgment of receipt and agreement to the
X
APPLICANT'S SIGNATURE
CUNA MUTUAL GROUP, 95, 98, 99, 2000, 01, ALL RIGHTS RESERVED
X
(SEAL)
DATE
OTHER SIGNATURE
(SEAL)
DATE
CFLA24 (LASER)