Access Credit Union Loan Application

Are you a member of Access Credit Union? *
yes   no
To indicate the type of credit you are applying for, check one of the following:
Individual Credit: Complete Applicant sections if you are relying only on your income and assets to establish credit.
Joint Credit: Complete Applicant and co-Applicant sections providing information about you and the other party.
I / WE apply for a closed-end Loan of: $ to be used for:
repaid in months or with a minimum monthly payment of: $
By: Mail Payroll Deduction
From: Checking Savings

I am applying for the following type of credit:
Vehicle (Description)
 
Unsecured
Secured Loan with Title
 
Stock
Share Account Secured (Acct. Number)
 
Other (Describe)

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Applicant Information

*Required Fields
Applicant   
Co-Applicant
(Relationship= )

* Name:
(Last - First - Initial)

* Are you a member of Access Credit Union:
Yes No
Yes No
Social Security Number:
* Present Address:
* City, State, and Zip
 
Own     Rent
Own     Rent
Monthly Rent/ Mortgage Payment:
Years at this address:
Previous Address:
City, State, Zip:

Own     Rent

Own     Rent

Birth Date:
Driver's License Number/State:
* Home Phone:
Business Phone:
E-Mail Address:
 
How would you prefer to be contacted?
Home Phone
Work Phone
Cell Phone
Email Address
Other
Special Instructions/Comments:
 
Complete for joint credit, secured credit, or if you live in a community property state:

Married
Separated
Unmarried (single, divorced, widowed)

Married
Separated
Unmarried (single, divorced, widowed)

Numbers of dependents other than self.
List ages of dependents not listed by other Applicant (exclude self):

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Employment Information

  Applicant    Co-Applicant
Present Employer:
Address of Employer:
Your Title/Grade:
Supervisor's Name:
Supervisor's Phone Number:
Start Date:
Hours at Work:
Self-Employed:
Yes No
Yes No
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.

 
Gross Net
$ per
Gross Net
$ per
Other Income:
Sources:

If employed in current position less than two years, complete the following:
Previous employer name and address:

Starting Date:

Ending Date:

Starting Date:

Ending Date:

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Reference (Please include Street, City, State, and Zip)
  Applicant    Co-Applicant
Name and address of nearest relative
not living with you:
Relationship:
Home Phone:
Name and address of business/personal reference:
Relationship:
Home Phone:
Financial Statement

Loans and Obligations (include Spouse / Co-Applicant , if that section on original application completed)
Check One (Applicant , Co-Applicant )

Creditors / Credit Cards Address / Account Number Purpose Original Amount Present Balance Monthly Payment  


$ $ $

Applicant

Co-Applicant
$ $ $

Applicant

Co-Applicant
$ $ $

Applicant

Co-Applicant

$ $ $

Applicant

Co-Applicant

$ $ $

Applicant

Co-Applicant

$ $ $

Applicant

Co-Applicant

$ $ $

Applicant

Co-Applicant

$ $ $

Applicant

Co-Applicant

$ $ $

Applicant

Co-Applicant
Subtotal OTHER Loan Detail:
$ $ $  
TOTALS:
$ $ $

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Financial Information
(If you answer yes to any of these questions, provide details below)
These questions apply to both Applicant and Other. Applicant Other
Are any of your debts past due? Yes     No Yes     No
Have you had your auto, furniture or property repossessed? Yes     No Yes     No
Have you ever filed for bankruptcy? Yes     No Yes     No
Are you a co-maker on a loan? Yes     No Yes     No
Net Worth
Name of
Institution
Identification
Data
Year
Purchased
Price
Balance
Owed
Present
Value
Home
Other Real Estate
Auto
(List Make/Model Year)
Savings
 
Checking Account
Stocks/Bonds
 
Other
 
 

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Insurance Information
Credit Life and Credit Disability insurance is available to protect your loan. Credit Life insurance can reduce or pay off your loan if you die. Credit Disability insurance can help make your loan payments if you should become disabled and unable to work.
To be eligible for Group Life and Disability insurance:
You and your co-Applicant must be under age 70 for Credit Life insurance or under age 66 for Credit Disability insurance to apply for these coverages.
You must be presently working outside the home for wages or profit for 25 hours or more per week for the past 30 days or more to apply for Credit Disability insurance.

During the last two years, you and your co-Applicant have NOT been medically advised of or treated for: cancer, heart attack or coronary artery disease, stroke, cirrhosis, Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC).

I understand that this is not an application for insurance. This insurance is voluntary and is not a condition for approval of my loan or credit plan. I plan to apply for the insurance coverage(s) checked below. Insurance coverage will become effective, after I apply and meet the eligibility requirements of the group policies, when my loan is approved.
Single Credit Life
Joint Credit Life
Credit Disability
Joint Credit Disability
Yes No
Yes No
Yes No
Yes No
MECHANICAL BREAKDOWN INSURANCE (AUTO LOANS ONLY)
I wish to apply for: Mechanical Breakdown Insurance. Yes No
Vehicle Coverage Plans (see brochure)
Policy Period: Months: Miles:

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MASTER APPLICATION SIGNATURES

PLEASE READ BEFORE SIGNING:
All the information in this application is true. I understand that section 1014 Title 18 U.S. Code makes it a federal crime to knowingly make a false statement on this application. You have my permission to check it. You may retain this application even if not approved. I understand that you may receive information from others about my credit and you may answer questions and requests from others seeking credit or experience information about me or my accounts with you. If this application is approved, I agree to honor the provisions of the credit or loan agreement and security agreement covering my account or loan. (If the application is for two of us, this statement applies to both of us.)
Applicant 's Signature:
Co-Applicant 's Signature:



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