Blackhawk Area Credit Union
LOAN REQUEST
Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information. The items marked with (*) are required fields.

Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself and the Co-Applicant section about your spouse if:

  1. You live in or the property pledged as collateral is located in a community property state (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 Co-Applicant section to the extent possible about the person on whose payments you are relying.

If you are applying for Joint Credit with another person, complete the Applicant and Co-Applicant sections.


TYPE AND AMOUNT OF CREDIT YOU'RE REQUESTING
Is this your first loan from us? Yes No
Amount/Credit Limit Requested: $

Approximate Time to Repay:

Months:
(Must be greater than $20,000 for 72 month term.)
Loan Type:
Security Offered:
(for secured credit only, not applicable to credit cards)
Type of Credit: Individual Joint

For Credit Cards, see Disclosure Table

PAYMENT PROTECTION COVERAGE Check if desired
Find out more about Payment Protection Insurance and why it's a better consumer value when offered through your credit union.

Check coverage(s) desired. We will disclose the cost of this Payment Protection Insurance - Credit Disability and Credit Life - to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective

Yes No
Do you want your loan protected for you and your family if you become disabled?
Yes No
Do you want your loan protected for you and your family in the event of your death?

 

TELL US ABOUT YOURSELF
If information for Co-applicant is SAME AS APPLICANT please fill in the Co-applicant blank with "SAA
Applicant Co-Applicant
*Name: Name:
CU Account #:  CU Account #: 
Social Security #: Social Security #:
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:
Married Separated
Unmarried (Single - Divorced - Widowed)
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:
Married Separated
Unmarried (Single - Divorced - Widowed)
Drv. License #: State: Drv.  License #: State:
Birth Date: Birth Date:
Home Phone: Home Phone:
Business Phone: Business Phone:
*E-mail: E-mail:

Present Address:

Present Address:
City: City:
State: State:
Zip: Zip:
Years There: Own Rent Years There: Own Rent
Personal Reference:  Phone: Personal Reference:
Phone:

 

TELL US ABOUT YOURSELF cont.
Applicants Debts Co-Applicants Debts
Mortgage/Rent owed to: Mortgage/Rent owed to:
Balance (Mortgage only): Balance (Mortgage only):
Monthly Payment:
Current APR % (Mortgage only):
Monthly Payment:
Current APR % (Mortgage only):
Person Responsible for Payment: Person Responsible for Payment:

 

 

TELL US ABOUT YOURSELF cont.
Applicants Other Debts Co-Applicants Other Debts
DEBT: DEBT:
Balance: Balance:
Monthly Pmt: Monthly Pmt:
DEBT: DEBT:
Balance: Balance:
Monthly Pmt: Monthly Pmt:
DEBT: DEBT:
Balance: Balance:
Monthly Pmt: Monthly Pmt:
DEBT: DEBT:
Balance: Balance:
Monthly Pmt: Monthly Pmt:

Please list any other debts in this box:

Please list any other debts in this box:

 

TELL US ABOUT YOURSELF cont.
Applicants Income Co-Applicants Income
Employer: Employer:
How long: How long:
Income: $ Net Gross
Annual Monthly Bi-weekly Weekly
Income: $ Net Gross
Annual Monthly Bi-weekly Weekly
Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)
Source:
$ Annual Monthly Hourly
Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)
Source:
$ Annual Monthly Hourly

 

CREDIT CARD DISCLOSURES
CREDIT CARD DISCLOSURE   GENY CLASSIC PLATINUM
Annual Percentage Rate for Purchases:   7.95% 11.95% 9.95%
Other APRs
Cash Advance APR:
Balance Transfer APR:
  7.95% 11.95% 9.95%
Introductory Offer for 6 Billing Cycles:   N/A 7.95% 7.95%
Grace Period for Repayment of the Balance for Purchases:   25 days 25 days 25 days
Grace Period for Cash Advances:   NONE NONE NONE
Method of Computing the Balance for Purchases:   AVERAGE DAILY BALANCES (INCLUDING NEW PURCHASES)
Annual Fees:   NONE NONE NONE
Minimum Finance Charge:   NONE NONE NONE
Transaction Fee for Purchases:   NONE NONE NONE
Transaction Fee for Cash Advances:   NONE NONE NONE
Balance Transfer Fee:   NONE NONE NONE
Late Payment Fee:   $25.00 $25.00 $25.00
Over the Credit Limit Fee:   $25.00 $25.00 $25.00
Card Replacement Fee:   $10.00 $10.00 $10.00
PIN Replacement Fee:   $2.00 $2.00 $2.00
This information is accurate as of 02/23/2010 and is subject to change after that date.
Please contact the credit union at 1-800-526-0579 for any changes to this information.
If you answer "yes" to any question other than #1, explain on an attached sheet.
Applicant
Co-Applicant
Yes
No
Yes
No
1. Are you a U.S. citizen or permanent resident alien?
2. 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 ?
3. Is your income likely to decline in the next two years?
4. Are you a co-maker, co-signer or guarantor on any loan not listed above?

If yes to question 4, complete the following:
For whom:
(Name of other obligated on loan):
To whom:
(Name of creditor):

NOTICE TO OHIO RESIDENTS: The Ohio laws against discrimination require all creditors make credit equally available to all credit worthy 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.

IN SUBMITTING THIS FORM: You promise that everything you have stated in this request is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You also agree to notify us of any change in your name, address or employment within a reasonable time thereafter. You authorize the credit union to obtain credit reports in connection with this request. 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. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on requests made to Federal Credit Unions or State Chartered Credit Unions insured by the NCUA. You understand that the credit union will rely on the information in the request and your credit report to make its decision. 

By submitting this loan request, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment.

By submitting this loan application you authorize the credit union to obtain credit reports in connection with this request.


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