Card Information
|
Card Type
VISA Classic Card
Master Card |
| Limit requested |
|
| Are you an existing
<Institution Name> customer?
Yes
No |
| If yes, what is your Account
Number |
|
| Credit
Type (for joint property states only) |
|
You may apply for individual or joint
credit, but choose only one of the following.
Thank you.
Individual Credit - unmarried applicant
Individual Credit - married applicant
Joint Credit - with your spouse
Joint Credit - with an applicant or cosigner who
is not your spouse
Notice to married
applicant: No provision of a
marital property agreement, a unilateral
statement under Wis. Stat. sec 766.59 or a court
decree under Wis Stat. sec 766.70 adversely
affects the interests of the credit union unless
prior to the time the credit is extended, the
credit union is furnished with a copy of the
agreement statement or decree, or has actual
knowledge of the adverse provision when the
obligation to the credit union is incurred.
|
Personal Information
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| First Name: |
|
| Middle Initial: |
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| Last Name: |
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| Social Security Number: |
|
| Marital
Status: |
Married
Unmarried |
| (includes single,
widowed and divorced) |
| Birthdate |
(xx/xx/xxxx) |
| Home Address: |
|
| City: |
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| State: |
|
| Zip: |
|
| How Long? |
|
| If you've lived at
your current address less than 2 years, please
provide your previous home address: |
| Previous Home Address: |
|
| City: |
|
| State: |
|
| Zip: |
|
| Home Phone Number: |
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Employment Information
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| Work Phone Number: |
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| Employer name: |
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| Address: |
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| City: |
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| State: |
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| Zip: |
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| Position: |
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Income
& Asset Information
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| Gross monthly income: |
|
| Other income |
Note: Alimony, child support or separate
maintenance income need not be revealed if you
do not wish to have it considered as a basis for
repaying this obligation. |
| Savings/Checking balance |
|
| Real Estate- locations, value |
|
| Auto - year, make model |
|
| Other Asset |
|
| Other Asset |
|
Debt Information
List all debts and credit
accounts, replacing "Other" with
description. If those listed do not apply,
please say "None" for balance
& payment..
|
|
Balance
|
Monthly Payment
|
| Rent or Mortgage |
|
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| Credit Card |
|
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| Auto Payments |
|
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Insurance and Payment Options
|
Credit Life and
Credit Disability Insurance
This insurance is available to help protect you
in the future. Credit life and credit disability
insurance are not required to obtain credit.
(insert fees and a link to insurance information
here....)
I request the following
Insurance Coverage:
Automatic Loan Payment Method
You do not have to select an
automatic payment method to obtain credit. These
are offered to you as a service from our
institution. We will contact you with full
details on this method of payment if you select
it as an option. (If your institution
offers lower rates for this payment method,
note that here)
Automatic Loan Payment
(Payment is transferred monthly on the due
date.)
From
Savings
From
Checking
|
| Any comments or
questions you may have for us?
Email Address:
By submitting this
application, I/We certify that this information
has been supplied truthfully, accurately and
voluntarily, and therefore authorize
<Institution Name>. to investigate our
creditworthiness, credit history and financial
responsibility through any credit bureau or by
any other reasonable means for consideration for
the loan applied for, or for any other services
offered. This application does not
constitute a contract for the extension of
credit.
Thank You. Upon receipt
of this application, someone at <Institution
Name> will review your information and get
back to you to extend credit, with additional
questions or to request further
information. We appreciate this opportunity to
be your financial partner. |
