EmailMe Form - LNFCU - Secure Online Application

*Apply For: *

Primary Borrower Information:

Name

First Middle Last

Account Number

SSN

Date of Birth

MM / DD / YYYY

Address

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

Home Phone

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

Cell Phone

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

Work Phone

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

Employer

Monthly Gross Income

$ Dollars . Cents

Monthly Mortgage / Rent Payment

$ Dollars . Cents

Secondary Borrower Information:

Name

First Middle Last

Account Number

SSN

Date of Birth

MM / DD / YYYY

Address

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

Home Phone

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

Cell Phone

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

Work Phone

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

Employer

Monthly Gross Income

$ Dollars . Cents

Monthly Mortgage / Rent Payment

$ Dollars . Cents

General Borrower Information:

Amount you wish to borrow

$ Dollars . Cents

Purpose for loan

Phone number where you can be reached

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

E-mail address where you can be reached

Additional Borrower Information:

Reference Name (Not living with you) & Relationship

First Middle Last

Phone number

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

Address

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

* Spousal support, child support, or separate maintenance income need not be revealed if you do not choose to have it considered for repayment of this loan.

I/We promise that everything I/we have stated in this application is correct to the best of my/our knowledge. If there are any important changes I/we will notify the credit union immediately. I/We authorize LNFCU to obtain credit reports in connection with this application for credit and for any update, renewal or extension of the credit received. I/We understand that LNFCU will rely on the information in this application and my/our credit report(s) to make its decision. If I/we request, LNFCU will tell me/us the name and address of any credit bureau from which it received a credit report on myself/us. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions insured by NCUA.