Loan Application

* Required Fields
Application Type:
Please Tell Us About Yourself (Primary Borrower)

Have you ever filed Bankruptcy?
Are you a co-maker on other loans:
Please Tell Us About Your Job (Primary Borrower)
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
The following information pertains to CO-BORROWER
Please Tell Us About Yourself (Co-Borrower)
Joint Applicant:

Please Tell Us About Your Job (Co-Borrower)
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
Please List Nearest Relative Not Living With You

Please List An Additional Relative Not Living With You

Statement of Total Indebtedness and Liabilities
Mortgage or Rent
Auto Loan
Credit Union
Credit Card
Credit Card
Child Support / Alimony / Separate Maintenance


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?):

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