Cheshire County Federal Credit Union Checking
Savings Loans
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Application

Consumer Loans or Credit Card

Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:

  1. you live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI),
  2. your spouse will use the account; or
  3. you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about the person on who's payments you are relying.

Joint Credit: Each Applicant must individually complete the appropriate section below. If Co-Borrower is spouse of the Applicant, mark the Co-Applicant Box.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.


Indicate the type of loan/s you are applying for:   Consumer Loan   Credit Card   Both


If applying for a Consumer Loan:
Individual    Joint    Amount Requested:    Purpose/Collateral:
Repayment:    Payroll Deduction    Cash    Military Allotment    Automatic Payment


Applicant


Full Name:

Mother's Maiden Name:

Account Number:

Social Security Number:

Drivers License Number:

Drivers License State:

Birth Date:

List ages of dependents not listed by other applicant (Exclude Self):

Home Phone:

Business Phone/Ext.:

Email Address:

Present Address (Street - City - State - Zip):

Own   Rent Years at this address:

Previous Address (Street - City - State - Zip):

Own   Rent Years at this address:

Complete for Joint Credit, Secured Credit or if You Live in a Community Property State:
Married    Separated
Unmarried (Single - Divorced - Widowed)

Employment Income

Name And Address of Employer:

Title/Grade:

Start Date:

Hours At Work:

Supervisor's Name:

If Self Employed,
Type of Business:

NOTICE: Alimony, child Support, or separate maintenance income need not be revealed if you do not choose to have it considered.

Employment Income:
$ per
Net Income    Gross Income

Other Income:
$ per
Other Income Source

Military: Is Duty Station Transfer Expected During Next Year?
Yes    No    If Yes, Where?
Ending/Separation Date:

Previous Employer Name And Address if Employed Less Than Five Years:

Start Date:

End Date:

Applicant Reference

Name And Address of Nearest Relative Not Living With You:

Relationship:

Home Phone:

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Other:
Co-Applicant    Spouse    Guarantor


First Name:

Mother's Maiden Name:

Account Number:

Social Security Number:

Drivers License Number:

Drivers License State:

Birth Date:

List ages of dependents not listed by other applicant (Exclude Self):

Home Phone:

Business Phone/Ext.:

Email Address:

Present Address (Street - City - State - Zip):

Own   Rent Years at this address:

Previous Address (Street - City - State - Zip):

Own   Rent Years at this address:

Complete for Joint Credit, Secured Credit or if You Live in a Community Property State:
Married    Separated
Unmarried (Single - Divorced - Widowed)

Employment Income

Name And Address of Employer:

Title/Grade:

Start Date:

Hours At Work:

Supervisor's Name:

If Self Employed,
Type of Business:

NOTICE: Alimony, child Support, or separate maintenance income need not be revealed if you do not choose to have it considered.

Employment Income:
$ per
Net Income    Gross Income

Other Income:
$ per
Other Income Source

Military: Is Duty Station Transfer Expected During Next Year?
Yes    No    If Yes, Where?
Ending/Separation Date:

Previous Employer Name And Address if Employed Less Than Five Years:

Start Date:

End Date:

Applicant Reference

Name And Address of Nearest Relative Not Living With You:

Relationship:

Home Phone:

What You Owe

Creditor Name Other Than This Credit Union

Interest Rate

Present Balance

Monthly Payment

Owed By
Applicant/Other

Rent
Own
% $ $
2nd Mortgage % $ $
1st Auto Loan % $ $
2nd Auto Loan % $ $
Child Care % $ $
Child Support % $ $
Credit Card % $ $
Credit Card % $ $
Other % $ $
Other % $ $
List any names under which your credit references and history can be checked.
TOTALS $ $    

What You Own

List A Location of Property or Financial Institution

Market Value

Pledged As Collateral For Another Loan

Owned By
Applicant/Other

Home $ Yes No
Auto $ Yes No
Savings $ Yes No
Checking $ Yes No
Other (Describe) $ Yes No

Other Information About You

If you answer "YES" to any question below other than the first please explain in the area provided below.

Are you a U.S. citizen or permanent resident alien?

Yes    No

Do you currently have any outstanding judgments or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit?

Yes    No

Is your income likely to decline in the next two years?

Yes    No

Are you a co-maker, co-signer or guarantor on any loan not listed above?

Yes    No

If so, to whom?     

If you answered "YES" to any question above other than the first please explain here:

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

WISCONSIN RESIDENTS ONLY: (1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

Signature For Wisconsin Residents Only:     Date:


You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension, or collection of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.

Applicants Signature:     Date:
Other Signature:     Date:

    

NMLS #485782

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STATEMENT OF POLICY ON PRIVACY OF INFORMATION

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