ONLINE LOAN APPLICATION

Secured Unsecured
How to Apply	Please complete application completely Press the submit button at the end of the application An incomplete application may delay processing You must fax a copy of your latest pay check stub to 361-882-5599
Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse, if: 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). your spouse will use the account, or 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 whose payments you are relying. Joint Credit: If you are applying with another person, complete the Applicant and Other sections. Guarantor: Complete the Other section if you are a guarantor on an account/loan.
Check below to indicate the type of account(s) and type of credit for which you are applying. Married applicants may apply for a separate account.
Account/Loan: Individual Joint Amount Requested $ Purpose/Collateral: (Including ATM/Debit Card Access to the Account if Available) Repayment: Payroll Deduction Cash Military Allotment Automatic Payment
Payment Protection	Single Credit Disability Insurance Single Credit Life Insurance Joint Credit Life Insurance	Check coverage(s) desired. The credit union will disclose the cost of this voluntary insurance to you. A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.

Applicant:		Other: Co-Applicant Spouse Guarantor
Name (Last/First/Initial)		Name (Last/First/Initial)
Account Number	Social Security Number	Account Number	Social Security Number
Driver's License Number/State	List ages of dependents not listed by other applicant (Exclude Self)	Driver's License Number/State	List ages of dependents not listed by other applicant (Exclude Self)

Birth Date

Home Phone

Business Phone/Ext.

Birth Date

Home Phone

Business Phone/Ext.

Present Address (Street / City / Zip)	Own Rent	Present Address (Street / City / Zip)	Own Rent
	Years at this Address		Years at this Address
Previous Address (Street / City / Zip)	Own Rent	Previous Address (Street / City / Zip)	Own Rent
	Years at this Address		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)		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		Employment / Income Name and Address of Employer

Title/Grade	Start Date	Hours at work	Title/Grade	Start Date	Hours at work
Supervisor's Name	If self employed, type of business		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.			Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income $ per $ per Net Gross                  Source			Employment Income $ per $ per Net Gross                  Source

Military: Is duty station transfer expected during next year? Yes No Where                              Ending/Separation Date	Military: Is duty station transfer expected during next year? Yes No Where                              Ending/Separation Date
Previous employer name and address if employed less Than five years Starting Date Ending Date	Previous employer name and address if employed less Than five years Starting Date Ending Date
Applicant Reference Name and Address of Nearest Relative Not Living with you Relationship Home Phone	Other Reference Name and Address of Nearest Relative Not Living with you Relationship Home Phone

What You Owe	Creditor name other than this credit union (Attach additional sheet(s) if necessary)	Interest Rate	Present Balance	Monthly Payment	Owed by
					Applicant	Other
Rent 1st Mortgage (include Tax and Ins.)
2nd Mortgage
1st Auto Loan
2nd Auto Loan
Child-Care
Child Support
Credit Card
Credit Card1
Other
Other1
List any names under which your credit references and credit history can be checked.		Totals:

What You Own	List 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 other than #1, explain in the text box below.	Applicant		Other
		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?       For Whom (Name of Others Obligated on Loan):         To Whom (Name of Creditor):
Explanation:

FOR CREDIT UNION USE ONLY
REPAYMENT TERMS
Daily Periodic Rate	Annual Percentage Rate %	Fixed Variable	Other Fees (Amount and Description) $		New Balance $
Amount Advanced $	Payment Amount $	Date Due	Payment Frequency	Line of Credit Limit $	Remaining Limit $
SECURITY OFFERED CONSUMERS' CLAIMS AND DEFENSES
The advance is secured by your shares. All property securing other plan advances and loans received in the past or in the future and the following property:
Property/Model		Year	I.D. Number		Value
Pledge of Shares and/or deposits $			Account Number(s)

Signatures
You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. 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, renewal or extension 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.
_________________________________ Applicant _________________________________ Date	_________________________________ Co-Applicant/Spouse/Guarantor _________________________________ Date

Loan Application - Printed Version 1) PLEASE PRINT THEN SIGN AND FAX APPLICATION TO 361-882-5599. 2) PRESS SUBMIT TO SEND AN ELECTRONIC COPY TO THE CREDIT UNION.

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