Secure Online Loan Request

Will loan be secured by collateral?  (Ex: Vehicle, Mobile Home, Etc.) *
 
Applicant Employment Income
Alimony, Child Support, or separate maintenance income need not be revealed if you do not choose to have it considered.
 Employer Name / SourceGross Monthly Income ($)Employment Start Date
Income Source:
Income Source:
Income Source:
Housing Obligations:  Do you rent or own your home? *
Does your mortgage payment include escrow for Property Tax? *
 
Does your mortgage payment include escrow for Homeowner's Insurance? *
 
Marital Status *
Will there be a co-applicant for this loan? *
Will there be a co-applicant for this loan? *
Spouse's Employment Income
Alimony, Child Support, or separate maintenance income need not be revealed if you do not choose to have it considered.
 Employer / SourceGross Monthly Income ($)Employment Start Date
Income Source:
Income Source:
Income Source:

Acknowledgement Required: Notice for Married Applicants not Applying with Spouse

The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned. 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.

Please sign if you are not applying for this account or loan with your spouse. *
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Co-Applicant Employment Income
Alimony, Child Support, or separate maintenance income need not be revealed if you do not choose to have it considered.
 Employer / SourceGross Monthly Income ($)Employment Start Date
Income Source:
Income Source:
Income Source:
Marital Status of Co-Applicant *
 

Acknowledgement Required: Notice for Married Co-Applicant not Applying with Spouse

The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned. 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. 

Co-Applicant sign here if not applying for this account or loan with your spouse. *
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Other Information *
 YesNo
Are you a US Citizen or Permanent Resident Alien?
Have you ever filed for bankruptcy or had a debt adjustment plan confirmed under Chapter 13?
Do you have any outstanding judgments?
Have you had property foreclosed upon or repossessed in the last 7 years?
Is your income likely to decline in the next two years?
Are you a co-maker, co-signer, or guarantor on any loan not listed above?

Authorization

By signing or otherwise authenticating below, you promise everything you have stated in this 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.  You understand 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 crime to willfully and deliberately provide incomplete or incorrect information in this application.

By signing or otherwise authenticating below, you also agree to be contacted by phone or email.

Signature of Applicant * 🛈
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Signature of Co-Applicant *
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County-City Credit Union is an Equal Opportunity Lender and Federally Insured by NCUA.

Please click "Submit" below to submit your request. Thank you!

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