Preliminary Loan Application

Name:__________________________________________________________________

Social Security Number:__________________________Acct #___________________

Driver’s License #/State:__________________________________________________

DOB:___________________Home & Business Phone:_________________________

Type of Loan Applying For: _______________________________________________

E-Mail Address:_________________________________________________________

Present Address:_________________________________________________________

__________________________________________________________

Previous Address:________________________________________________________

________________________________________________________

Employer Name & Address:_______________________________________________

Occupation:____________________________________________________________

Start Date:______________________ Hours @ Work:_________________________

Employment Income:___________________Other Income:_____________________

Previous Employer Name & Address:_______________________________________

________________________________________________________

Applicant Reference Name & Address:______________________________________

________________________________________________________

What You Owe:

Rent:___________________ Mortgage:___________________Auto:______________

Child Support:______________ Credit Cards:_____________Other:_____________

You promise that everything you have stated in this preliminary application is correct to the best of your knowledge. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, renewal or extension of credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its lending decision.

Applicant’s Signature Date