Application - Green River Basin FCU

MMM
GREEN RI\TER BASIN FCU
131 EAST RAILROAD AITE
RIVER, I,ITY 82935
Pb.one : (307) 875-3044
Fax
: (307) 875-0137
GREEN
Application
Marneo Appilcanrs: May appty ror a separate account.
Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:
1 . you live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, lD, LA, NM, NV, TX, WA, Wl),
2. your spouse will use the account, or
3. you are relying on your spouse's income as a basis for repayment. lf 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: Each Applicant must individually complete the appropriate section below. lf Co-Borrower is spouse of the Applicant, mark the Co-Applicant
box.
Guarantor: Complete the Other section if you are a guarantor on an accounUloan.
LOANLINER AccounUloan:
(lncluding AT[,VDebit Card Access to the Account if Available)
Amount Requested $
Purposey'Collateral:
Repayment:
TAYMENT
PRorEcrloN
I lre you interested in having your toan protected? n yes n ruo
frJ.?hilliys';J"""i T""#;'*: :',::r[r*n,yr'''o*:iiSlli: i8'*"":l|}"":i'J,i#I fifJ$"il:
signed for protection
to be effective.
4PPLICANT
OTHfR
NAME
NAME
TASSWUHU
ACCOUNT NUMBEH
PASSWORD
ACCOUNT NUMBER
SOCIAL SECURITY NUMBER
UhIIVEH'S LICENSE NUMBER/STATE
sUUIAL SECUHI I Y NUMEIER
DFIVEB'S LICENSE NUMBER/STATE
EMAIL ADDRESS
AGES OF DEPENDENTS
hMAIL AUUHESS
UAIE
PHESEN
I
HUME
PHUNb
BUSINESS PHONSEXT.
tsIHI H
AUDHESS
DATE
HOME
PHONE
BUSINESS PHONSEXT
PRESENT ADDRESS
-ENGIH AT FESIDENCE
THEVIUUS AUUHE5S
LENGTH AT RESIDENCE
PTIEVIOUS ADDRESS
-ENGIHAI
HESIIJENCE
LENGIHAI HESIDENCE
vvMFLE t E rVH JgtN t UHEUil, SEUUHEU UHEUil OH tF yOU LIVE lN A COMMUNITY
PROPERTY STATE:
PROPERTY STATE;
MARITAL STATUS:
MARITAL STATUS:
EMPLOYMENT/INCOI,IE
| $
EMPLOYMENT/INCOME
PER
NAME AND
LE/UffiUts
JUPbFIVISOR'S
PEF
NAME AND
AODRESS OF
EMPLOYER
ADDRESS OF
EMPLOYER
II
| $
ISTART
NAME
DATE
I
HOURS AT WORK
IIF SELF EMPLOYED, TYPE OF BUSINESS
IITLSGRADE
sUPEHVISOH'S
ISTART
NAME
DATE
IHOURS ATWORK
IIF SELF EMPLOYED, TYPE OF BUSINESS
TUIIUts: ALIMUNY, CHILU SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE
REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.
I9IIUE: ALIMUNY, UHILU SUPPQHI, OH SEPARATE MAINIENANCE INCOME
)THER INCOME
OTHER INCOME
F
D
I
D
pen
SOURCE
pen
SOURCE
pen
SOUBCE
pen
SOURCE
t 4PEU I EU UUHING NEX
,VHERE
TNEVIVUJ IMFLVf EN ITAME AIIU AUUHEII
FIVE YEARS
pen
pen
pen
pen
$
$
$
$
I
YTAfI''
ENDING/SEPARATION
IF EMTLUYEU LE55 IHAN
I: IJ UUI T DIAIIVN
DATE
siIAHIING DATE
souRcE
souRcE
souRcE
souRcE
IFAN-FEH iltsEVIEU
,T,HERE
UUHINq NtrAI I4H'
ENDING/SEPARATION
FHtrVIUU5 EMHLUYEH NAME ANU AUUHES$ IF EMPLOYED LESS
FIVE YEARS
THAN
ENE|NdSITE_
ffiFEngilCE
|
"ELArroNsHrP
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING W|TH YOU
HOME PHONE
@ CUNA MUTUAL
GROUP,1980,82,84,86,89,98,2000,01,03,04,07,
ALL RIGHTS RESERVED
NEED NOT BE
REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.
DATE
STARTING DATE
MdiNGSITE-
REFERET€E
I
NAME AND ADDRESS OF NEAREST RELATTVE NOT LTV|NG W|TH
PAGE
1
"EUIIUN.HIP
yOU
HdMFFmTF_
AXXO27 (LASER)
UHEUI I UH NAME U I IItsH I HAN I HIS CREDIT UNION
WHATYOU O\drf
I EHt!
(Attach additional sheet(s) it necessary)
-lST ANY NAMES UNDER wHlcH YOUR CREDIT REFERENCES AND CREDIT HISTORY CAN BE
A'HAT YOU OWN
CHECKED:
fOflf_S
I
owEu cY
|
RATE
PRESENT BALANCE
PAYMENT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
|$
ls
APPLICAN'I
OTHEF
OWNEU tsY
LIST LOCATION OF PROPERTY OR FINANCIAL INSTITUTION
MARKET VALUE
APPLICAN'I
OTHER
$
$
$
$
$
$
$
$
$
orHFR lNFoRuAnoN ABour
1.
2.
3.
4.
You
|
,,
"ou
ANSWER
'yEs' ro
ANy
euEsroN orHER rHAN
APPLICANT
DO YOU CURRENTLY HAVE ANY OUTSTANDING JUOGMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT PLAN
CONFIRMED UNDER CHAPTER 1 3, HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS, OR BEEN A PARTY IN A LAWSUIT?
IS YOUR INCOME UKELY TO DECUNE IN THE NEXT TWO YEARS?
ARE YOU A CO-MAKER, CO-SIGNER OR GUARANTOR ON ANY LOAN NOT LISTED ABOVE?
FOR WHOM (Name ot Others Obtigated on Loan):
TO WHOM (Name of Creditor):
STATE LAW
NOTTCES I OHIO
RESIDENTS
ONLY: The Ohio
unless the Credit Union is furnished a copy of the agreement, statement or
decree, or has actual knowledge of its teims, befoie the credit is granted
laws
against discrimination require that all creditors
make credit equally available to all creditworthy customers, and that credit
feporting agencies maintain separate credit hislories on each individual
upon request. The Ohio Civil Rights Commission administers compliance
,vith
f 1, ExpLArN oN AN ATTAcHED sHEEr
ARE YOU A U.S. CITIZEN OR PERMANENT RESIDENT AUEN?
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 marriag6' or faniily'of th6
this law.
undersigned.
(1) No provision of any marital property
rgreement, unilateral statement under Section 266.59; or court ddcre6
under Section 766.70 will adversely affect the rights of the Credit Union
WISCONSIN RESIDENTS ONLY:
IX
SIGNATURE FOR WISCONSIN RESIDENTS ONLY
S}GNATURES
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. l! there are any important changes you
will notify us in writing immediately. You authoiize ihe Credit U-nion to
obtain credit reports in connection with this application for credit and for
any update, increase, renewal, extension or collection of the
X
received. You understand that the Credit Union will rely on the information
in this application and your credit report to make its decision. lf 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. lt 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.
credit
llx
(SEAL)
APPLICANT'S SIGNATURE
DATE
nl
OTHER SIGNATURE
FOR CREDIT UNION USE ONLY
)ATE
APPROVED
DENIED
(Adverse Action Notice Sent)
APPROVED
LIMITS:
SIGNATURE
LINEOFCREDIT
OTHER
OTHER
$
$
$
$
DEBT BATIO/SCONE
BEFORE AFTER
-OAN OFFICER COMMENTS:
x
K
DATE
DATE
PAGE 2
AXX027 (LASER)