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Optional insurance to cover balance of loan in the event of death or disability is available. Contact the credit union during business hours for quotes.

Repayment
Type of Application
Individual    Joint
Purpose of loan
Amount Requesting
Name
Mother's Maiden Name
Account Number
Social Security
- -
Drivers License Number
Number of Dependants
(Exclude Self)
Birthday
- -
Home Phone #
- -
Work Phone #
- -
Email Address
Address
Own or Rent
Own    Rent
Years There
Previous Address (If less than 5 years)
Own or Rent
Own    Rent
Years There
Complete for joint credit, or secured credit
Married    Separated    Unmarried
Your Employer's Name

Employer's address

or shop Number

Supervisor
Occupation
Start Date
Gross Income
per
Week    Month    Year
# of hours worked per week
Other income
per
Week    Month    Year
Source

Previous Employer's Name & address if employed less than 5 years

Starting Date
Ending Date
Nearest relative not living with you?
Relationship
Home Phone
- -

Their address 

Other Reference
Relationship
Home Phone
- -

Their address 


Co-Applicant - If Applicable
Name
Mother's Maiden Name
Account Number
Social Security
- -
Drivers License Number
Number of Dependants
(Exclude Self)
Birthday
- -
Home Phone #
- -
Work Phone #
- -
Email Address
Address
Own or Rent
Own    Rent
Years There
Previous Address (If less than 5 years)
Own or Rent
Own    Rent
Years There
Complete for joint credit, secured credit
Married    Separated    Unmarried
Your Employer's Name

Employer's address

or shop Number

Supervisor
Occupation
Start Date
Gross Income
per
Week    Month    Year
# of hours worked per week
Other income
per
Week    Month    Year
Source

Previous Employer's Name & address if employed less than 5 years

Starting Date
Ending Date
Nearest relative not living with you?
 
Relationship
Home Phone
- -

Their address 

Other Reference
 
Relationship
Home Phone
- -

Their address 

What You Owe Creditor Name Other Than This Credit Union Interest Balance Payment Owed By  
Applicant Other
Rent or
First Mortgage
2nd Mortgage
1st Auto Loan
2nd Auto Loan
Child Care
Child Support
Credit Card
Credit Card
Other
Other

What You Own  List Location of Property or Financial Institution  Market Value   Pledged as collateral   Owned By
Yes No Applicant Other
Home
Auto
Savings
Checking
Other

 

Other Infomation About You Applicant
 Other
Yes No Yes No
Are you a U.S. Citizen or Permanent Resident Alien?
Do you currently have any outstanding judgements 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?
Is your income likely to decline in the new two years?
Are you a co-maker, co-signer, or guarantor on any loan not listed above?
    For whom (Name of others obligated on loans)
    To whom (Name of creditor)

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 immediatey. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension, or collection 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 recieved 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.

Do you agree with these conditions? Applicant
yes
Do you agree with these conditions? Co Applicant (If Applicable)
yes

By submitting this application, I authorize Remington Federal Credit Union to verify my employment and payroll information.