EmailMe Form - LOAN APPLICATION

LOAN APPLICATION

Married Applicants: May apply for a separate account.

Individual Credit: You must complete the Applicant section about yourself and the Co-Applicant 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, ID, LA, NM, NV, TX, WA, WI),
2. your spouse will use the account, or
3. 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 Co-Applicant 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. If Co-Borrower is spouse of the Applicant, mark the Co-Applicant box.

Guarantor: Complete the Co-Applicant section if you are a guarantor on an account/loan.

LOAN APPLICATION DISCLOSURE

Please remember to submit a current pay stub with your application. Pay stubs can be dropped off at the credit union or faxed to 334-364-2855.

Section Break

A description of the section goes here.

Amount Requested:

$ Dollars . Cents

Purpose/Collateral:

Repayment:

Are you interested in having your loan protected?

If you answer YES in having your loan protected, then the credit union will disclose the cost of this voluntary payment protection to you. A separate election which discloses the terms and conditions must be signed for protection to be effective.

Applicant Information

Name:

First Middle Last

Mother's Maiden Name:

First Middle Last

Account Number:

Social Security Number:

Driver's License Number:

Driver's License State:

Ages of Dependents:

Email Address:

Birth Date:

MM / DD / YYYY

Home Phone:

### - ### - ####

Business Phone/Ext:

### - ### - ####

Present Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Length at Present Residence:

Previous Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Length at Previous Address:

Marital Status:

Applicant's Employment/Income

Other Income Amount($):

Per:

Employer Name:

First Last

Employer Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Title/Grade:

Start Date:

MM / DD / YYYY

Hours at Work:

Supervisor Name:

First Last

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.

Other Income Amount($):

$ Dollars . Cents

Per:

Source:

Military: Is duty station transfer expected during the next year?

Where:

Ending/Separation Date:

MM / DD / YYYY

Previous Employer Name:

First Last

Previous Employer Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Previous Employer Start Date:

MM / DD / YYYY

End Date:

MM / DD / YYYY

Applicant's Reference Information (Nearest Relative Not Living with You)

Name:

First Last

Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Relationship:

Home Phone:

### - ### - ####

Co-Applicant Information (If Filing For Joint Credit)

Name:

First Last

Mother's Maiden Name:

First Last

Account Number:

Social Security Number:

Driver's License Number:

Driver's License State:

Ages of Dependents:

Email Address:

Birth Date:

MM / DD / YYYY

Home Phone:

### - ### - ####

Business Phone/Ext:

### - ### - ####

Present Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Length at Present Residence:

Previous Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Length at Previous Residence:

Marital Status:

Co-Applicant's Employment/Income

Income:

Per:

Employer Name:

First Last

Employer Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Title/Grade:

Start Date:

MM / DD / YYYY

Hours at Work:

Supervisor's Name:

First Last

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.

Other Income Amount($):

$ Dollars . Cents

Per:

Source:

Military: Is duty station transfer expected during the next year?

Where:

Ending/Separation Date:

MM / DD / YYYY

Previous Employer Name:

First Last

Previous Employer Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Starting Date:

MM / DD / YYYY

Ending Date:

MM / DD / YYYY

Co-Applicant's Reference Information (Nearest Relative Not Living with You)

Name:

First Last

Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Relationship:

Home Phone:

### - ### - ####

Applicant

	WHAT YOU OWE	CREDITOR NAME OTHER THAN EAMC	INTEREST RATE	PRESENT BALANCE	MONTHLY PAYMENT
Row1
Row2
Row3
Row4
Row5
Row6
Row7
Row8
Row9
Row10

Co-Applicant

	WHAT YOU OWE	CREDITOR NAME OTHER THAN EAMC	INTEREST RATE	PRESENT BALANCE	MONTHLY PAYMENT
Row1
Row2
Row3
Row4
Row5
Row6
Row7
Row8
Row9
Row10

List any names under which your credit references and credit history can be checked:

Applicant

	WHAT YOU OWN	LIST LOCATION OF PROPERTY OR FINANCIAL INSTITUTION	MARKET VALUE	PLEDGED AS COLLATERAL ON ANOTHER LOAN?
Row1
Row2

Co-Applicant

	WHAT YOU OWN	LIST LOCATION OF PROPERTY OR FINANCIAL INSTITUTION	MARKET VALUE	PLEDGED AS COLLATERAL ON ANOTHER LOAN?
Row1
Row2

Other Information About You (Applicant)

Are you a U.S. citizen or permanent resident alien?

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?

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?

For Whom (Names of others obligated on loan):

To Whom (Name of creditor):

Other Information About You (Co-Applicant)

Are you a U.S. citizen or permanent resident alien?

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?

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?

For Whom (Names of others obligated on loan):

To Whom (Name of creditor):

NOTICE: By submitting this application, 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, 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 received a credit report from you. It is a federal crime to wilfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.