Amount requested :
Purpose of loan :
Collateral to be used :
Collateral to be used :
First Name:
Last Name:
Current address:
City/State/Zip:
Date of birth/E-mail:
Home phone/
Work phone:
Employer:
Gross Monthly Income:
Number of Years at Job:
First Name:
Last Name:
Current address:
City/State/Zip:
Date of birth/E-mail:
Home phone/
Work phone:
Employer:
Gross Monthly Income:
Number
of Years at Job:
Alimony, child support, or separate maintenance income need not be listed unless you choose to have such income considered regarding extention and repayment of the credit request.
In addition to Rent/Mortgage list all other debts (for example, auto loans, credit cards, second mortgage, home association dues, alimony, child support, or child care). Please use a separate line for each credit card and auto loan.
Applicant and Co-applicant
Monthly payment:
----------------
Rent or mortgage
Credit card payment
Auto loans
Second mortgage
Home assoc. dues
Alimomy
Child support
other
Loan 1
Monthly payment:
----------------
Rent or mortgage
Credit card payment
Auto loans
Second mortgage
Home assoc. dues
Alimomy
Child support
other
Loan 2
Monthly payment:
----------------
Rent or mortgage
Credit card payment
Auto loans
Second mortgage
Home assoc. dues
Alimomy
Child support
other
Loan 3
Monthly payment:
----------------
Rent or mortgage
Credit card payment
Auto loans
Second mortgage
Home assoc. dues
Alimomy
Child support
other
Loan 4
Monthly payment:
----------------
Rent or mortgage
Credit card payment
Auto loans
Second mortgage
Home assoc. dues
Alimomy
Child support
other
Loan 5
Monthly payment:
----------------
Rent or mortgage
Credit card payment
Auto loans
Second mortgage
Home assoc. dues
Alimomy
Child support
other
Loan 6
Monthly payment:
----------------
Rent or mortgage
Credit card payment
Auto loans
Second mortgage
Home assoc. dues
Alimomy
Child support
other
Loan 7
Monthly payment:
----------------
Rent or mortgage
Credit card payment
Auto loans
Second mortgage
Home assoc. dues
Alimomy
Child support
other
Loan 8
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 all your debts and obligations. You authorize the Credit Union to check your credit, employment history, obtain a credit report and to answer questions about their credit experience with you. Prairie Federal Credit Union will retain this application whether or not the requested credit is granted. It is a federal offense for a person to knowingly make a false statement for the purpose of influencing the action of a Federal Credit Union.