Type of Loan
: Type of Credit Requested Select Type of Loan Vehicle Loan Share Loan Unsecured Loan Variable Home Equity REQUIRED
: Reason or Purpose for Loan
: $ Amount Requested
: Term of Loan Months
Name of Institution if Refinancing or Paying Off Another Loan:
NO YES It is my intent to apply for joint credit with (enter name of co-applicant) (co-applicant must fill out separate application)
(enter your initials)
: First Name
: Last Name
: Home Phone XXX-XXX-XXXX
: Work Phone XXX-XXX-XXXX : Ext
: Contact Preference Select Preference Cell Phone Home Phone Work Phone
: Cell Phone XXX-XXX-XXXX
: Personal E-mail Address Add my email to the E-Announcements List.
: Work E-mail Address Add my email to the E-Announcements List.
: Social Security Number XXX-XX-XXXX
: Home Address
: State Click to Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tenessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
What You Own
: Do you Rent or Own OWN RENT
: Rent or Mortgage/HE Payment
: Mortgage Company
Home Equity Information
If filling home equity loan application - fill in this section.
: Annual Property Taxes
: Annual Insurance Payment
: Annual Homeowner Association Fees
: Approximate Value of Home
Employment / Income
: Your Employer (1)
: Position (1)
: Address (1)
: $ Your Gross Monthly Income (1) (Alimony, child support, or separate maintenance income need not be revealed if you don't wish to have it considered as a basis for repaying this obligation.)
: FirstEnergy employees enter interoffice location (1)
: Second Job Employer (2)
: Position (2)
: Address (2)
: $ Gross Monthly Income (2) (Alimony, child support, or separate maintenance income need not be revealed if you don't wish to have it considered as a basis for repaying this obligation.)
: FirstEnergy employees enter interoffice location (2)
: Do you have rental income? NO YES : If yes, Amount monthly $ If yes, please provide proof of income such as current income tax forms.
: $ Child or Alimony Payments Received
Other Information About You
: Nearest Relative (not spouse)
: Phone Number
: Comments or Special Needs
: Have You Ever Been Through Bankruptcy NO YES : If yes, year
: Do you pay child support or alimony? NO YES If yes, Amount $
Is your income likely to decline in next 2 years? NO YES
: Are you a co-signer, co-maker on a loan? NO YES If yes, for whom
For Vehicle and Home Equity Loans provide 'Insurance Company' and 'Agent Name'
: Insurance Company
: Policy Number
: Agent Name
: Agent Phone Number
NO YES I understand that the credit union must perform a credit check, and authorize the credit union to obtain credit reports in connection with this credit request. ("YES" must be selected for loan application to proceed.)
By submitting this application to the credit union, you certify that everything you have stated in this application is correct to the best of your knowledge. All submittals are subject to verification of the information provided. You authorize the credit union to obtain credit reports in connection with this application for credit and for any update, renewal or extension of the credit received. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on applications made to Credit Unions insured by NCUA.
Please submit a copy of your two most current pay stubs or verification of Social Security and/or Pension Income. These items can be mailed or faxed to 330-535-9508.
If you do not hear from us within 24-36 hours, call the office at 330-535-3611.
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