Complete all applicable fields in this loan application in the spaces provided.

Select type of loan desired
Secured - Auto
Secured - Other
Unsecured/Signature
Prestige Line of Credit
Vacation

Member Account No. If Secured, Describe Collateral Amount Requested $

Payroll Deduction (select one)
First
Split
Last
NA

Purpose of Loan No. of Payments Desired months (Auto/Secured/Signature/Vacation loans only).

I would like more information about low-cost GAP coverage for my vehicle or boat loan.

Applicant Information

Full Name (Last, First, Middle) Social Security Number Birth Date Present Address (Street/City/State/Zip) Years at Present Address Home Phone   Cell Phone Work Phone   Ext. Email Address Ages of Dependents Present Employer (Name and Address) Date Of Hire Present Supervisor's Name: Supervisor's Work Phone   Ext. Gross Monthly Salary Present Position Previous Employer (Name and Address) Years with Previous Employer Are you a U.S. Citizen? Alimony, child support, or separate maintenance payments need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Other Income (Describe) $ Vehicle Insurance Information (Complete if applying for a vehicle loan) Insurance Company (Name and Phone Number) Name Phone Number

Co-Applicant Information

Full Name (Last, First, Middle) Social Security Number Birth Date Present Address (Street/City/State/Zip) Years at Present Address Home Phone   Cell Phone Work Phone   Ext. Email Address Ages of Dependents Present Employer (Name and Address) Date of Hire Present Supervisor's Name: Supervisor's Work Phone   Ext. Gross Monthly Salary Present Position Previous Employer (Name and Address) Name Address Years with Previous Employer Are you a U.S. Citizen? Alimony, child support, or separate maintenance payments need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Other Income (Describe) $ Vehicle Insurance Information (Complete if applying for a vehicle loan) - Insurance Company (Name and Phone Number) Name Address

Please list below all debts, including any alimony or child support. You may also list any accounts (paid out or open) which you wish the credit union to consider as a credit reference.

Rent or Mortgage Payable To Name of Company or Bank Present Balance Monthly Payment Auto Financed By Name of Company or Bank Present Balance Monthly Payment Other Debts Name of Company or Bank Present Balance Monthly Payment Other Debts Name of Company or Bank Present Balance Monthly Payment Other Debts Name of Company or Bank Present Balance Monthly Payment

Equal Housing Lender. We do business in accordance with the Federal Fair Housing Law and the Equal Credit Opportunity Act.