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Loan Application

* Required Fields

Best Time to Call You:

Best Phone # To Reach You:

Purpose of Loan:

Collateral:

Term:

Account Number:

Amount Requested:

Down Payment/Trade-in/Cash:

Credit Life

Credit Disability

Payroll Deduction

Application Type:

Individual

Joint

Please Tell Us About Yourself (Primary Borrower)

Full Name:

Street Address:

City:

State:

ZIP:

Years There:

Home Value:

Own

Buying

Renting

Your Vehicles: 1), Year:

Your Vehicles: 1), Make:

Your Vehicles: 1), Model:

Your Vehicles: 2), Year:

Your Vehicles: 2), Make:

Your Vehicles: 2), Model:

Other Property Owned:

Have you ever filed Bankruptcy?

Yes

No

Date, if yes:

Are you a co-maker on other loans:

Yes

No

If so, for whom?

How much?

Home Phone:

Work Phone:

Cell Phone:

Social Security Number:

Birth Date:

Email Address:

Please Tell Us About Your Job (Primary Borrower)

Current Employer:

Years There:

Phone Number:

Position:

Gross Monthly Salary/Hourly Income:

Monthly dollar amount that you receive in alimony, child support, or separate
maintenance - this income need not be revealed if you do not wish to
have it considered as a basis for repaying this obligation

Other Income:

Source:

The following information pertains to CO-BORROWER

Please Tell Us About Yourself (Co-Borrower)

Joint Applicant:

I intend to be a joint applicant on this loan application.

Full Name:

Street Address:

Street Address: Address Second Line

City:

State:

ZIP:

Years There:

Home Phone:

Work Phone:

Cell Phone:

Social Security Number:

Birth Date:

Email Address:

Your Vehicles: 1), Year:

Your Vehicles: 1), Make:

Your Vehicles: 1), Model:

Your Vehicles: 2), Year:

Your Vehicles: 2), Make:

Your Vehicles: 2), Model:

Other Property Owned:

Please Tell Us About Your Job (Co-Borrower)

Current Employer:

Years There:

Phone Number:

Position:

Gross Monthly Salary/Hourly Income:

Monthly dollar amount that you receive in alimony, child support, or separate
maintenance - this income need not be revealed if you do not wish to
have it considered as a basis for repaying this obligation

Other Income:

Source:

Please List Nearest Relative Not Living With You

Full Name:

Home Address:

Home Address: Address Second Line

City:

State:

ZIP:

Primary Phone Number:

Please List An Additional Relative Not Living With You

Full Name:

Home Address:

Home Address: Address Second Line

City:

State:

ZIP:

Primary Phone Number:

Statement of Total Indebtedness and Liabilities

Mortgage or Rent

Owed To Security:

Balance Owed:

Monthly Payment:

Landlord's Address:

Landlord's Phone #:

Auto Loan

Owed To Security:

Balance Owed:

Monthly Payment:

Credit Union

Owed To Security:

Balance Owed:

Monthly Payment:

Bank

Owed To Security:

Balance Owed:

Monthly Payment:

Credit Card

Owed To Security:

Balance Owed:

Monthly Payment:

Credit Card

Owed To Security:

Balance Owed:

Monthly Payment:

Other

Owed To Security:

Balance Owed:

Monthly Payment:

Child Support / Alimony / Separate Maintenance

Owed To Security:

Balance Owed:

Monthly Payment:

SIGNATURE - READ CAREFULLY BEFORE SIGNING. PER YOUR MEMBERSHIP AGREEMENT AND/OR LOAN AGREEMENTS WITH US YOU GIVE US A SECURITY INTEREST IN YOUR ACCOUNT(S) AND CERTAIN OTHER PROPERTY PLEDGED AS DESCRIBED IN SAID AGREEMENTS.

You agree and attest that your name and address shown herein is your legal name and the place of your residence, and such address is the proper address for all notice(s) required by this Application, and you further understand that any changes in this address must be submitted to us in writing to be effective. You agree that everything stated in this application, whether oral, written, or through FAX machine, is true and correct to the best of your knowledge. Each applicant, authorized user, guarantor, co-signer or other party signing below, (together herein referred to as "applicant(s)") hereby makes application for the account(s)/services/loan(s) indicated. Each applicant consents that the Credit Union may undertake to verify their eligibility for any account(s), loan(s) and service(s) now and in the future, including adjustment of credit limits. In addition, all applicants authorize us to make inquiry to determine your employment history and to obtain information concerning any accounts with other institutions and your credit history, including any credit reports. Applicants specifically consent that the Credit Union may report information concerning their account(s) services to others; and that we may provide the reasons (should we determine you to be ineligible for any services) to the other applicants. The Credit Union or its agent is authorized to investigate your creditworthiness, employment history, and to obtain a credit report and to answer questions about the credit history with you. You understand that any false or misleading statements in your application may cause any loan to be in default. You agree that this Application shall be the Credit Union's Property whether or not this Credit Application is approved.

NOTICE: By submitting this application by facsimile or electronically, you agree to the same terms that apply to a signed application. If there is a co-applicant on this loan, that co-applicant has authorized the submission of this application. This facsimile or electronic submission qualifies as your signature. It is understood that you will have to sign loan documents before funds can be disbursed. Indirect lending: If this application is submitted to the Credit Union by a third party such as a car dealer, you authorize us to disclose to such third party the Credit Union's loan decision including the reason(s) for its decision.

NOTICE to Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

Authorized User/Card You also request that an additional card be issued in the name of the Authorized User for use by the persons identified herein. The undersigned specifically acknowledge their responsibility for all purchases and/or cash advances made by the Authorized User or anyone that Authorized User allows to use any card(s) issued in connection with your credit card account. The Authorized User(s) may also be responsible for all purchases and cash advances they make or authorize.

SECURITY AGREEMENT AND PLEDGE. By signing this application, acceptance or authorized use of any credit card(s) issued, you pledge your shares as defined by your Credit Card Agreement to secure payment of your obligations on this account. You understand that collateral securing other loans will secure this account; and that property purchased with your credit card(s) will also secure this account.

Applicant Signature: __________________________________________________
Date: ____________________

Co-applicant Signature: ________________________________________________
Date: ____________________

Security Code (What's this?):

Security Code

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NCUA - This Credit Union is federally-insured by the National Credit Union Administration.
Equal Housing Lender - We do business in accordance with the Fair Housing Law and Equal Opportunity Credit Act.

Our credit union is committed to providing a website that is accessible to the widest possible audience in accordance with ADA standards and guidelines. If for some reason, you are using a screen reader or other auxiliary aid and are having problems using this website, please contact our Operations Coordinator at 937-767-7377. All products and services available on this website are also available at all of our branches. If you need more personal assistance in reviewing what we have to offer or taking advantage of our products and services, and prefer not to visit one of our branches, just give our Operations Coordinator a call. She is happy to talk with you to ensure that you can learn about and take advantage of all the products and services we offer.