Member Loan Application

MEMBER LOAN APPLICATION Applicant Information First Name: Social Security Number:

Middle Initial: Date of Birth:

Number of Dependents:

PO/Street Address: City:

Last Name:

State:

Driver's License Number:

Apt. No.:

Own Rent

Monthly Payment:

Zip:

How Long:

Home Phone:

Former Address if above address is less than 7 years:

Employment Current Employer:

How Long:

Address:

City:

City:

State:

Zip:

How Long:

Position/Title:

Monthly Salary: State:

Zip:

Work Phone:

Previous Employer/Address if current employer under 5 years:

Co-Applicant Information First Name: Social Security Number:

Middle Initial: Date of Birth:

How Long:

Last Name:

Monthly Salary:

Employer:

How Long:

Address:

City:

Work Phone:

Position/Title: State:

Zip:

Additional Income Additional Source of Income:

Monthly Amount:

Additional Source of Income:

Monthly Amount:

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References List Banks, Stores, Charge Cards, etc. Account With

Address

Account Number

Balance Owing

Monthly Payment

Checking Savings Mortgage Auto Loan Credit Acct. #1 Credit Acct. #2 Credit Acct. #3

Loan Amount / Purpose Amount:

Purpose:

The above information is correct and is given for the purpose of obtaining credit. You are authorized to verify this information and to obtain additional information in reviewing this credit request. Both Signatures are Required for a Joint Application _______________________________________

______________________________________

Applicant Signature

Joint Applicant Signature

_____________ Date

FOR SSVEC USE ONLY Date application received: _____________

Taken by: ________________________________________

Account Number: _________________

Premise Number: _______________

Service established date: __________Cooperative Credit Rating: _____________CDSW Rating: ____________ Term Length (in months): ___________

Payment Due:

1st

Has the applicant established credit as defined in the Cooperative’s rules?

or YES

15th NO

Other information or recommendations: _________________________________________________________ __________________________________________________________________________________________ A loan of not more than __________________ will be available to this member. ____________________________________________________________ Cooperative Representative

10/99

______________ Date

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