ࡱ>  n bjbj 0n0000$T40Rccc$%cc%% % %EmPK/]"0ReZ/ZmZmPcZ@41ccc cccR%%%%Zccccccccc : KRATON BELPRE FEDERAL CREDIT UNION APPLICATION FOR LOAN (Unsecured/Secured Closed End) NOTICE: The Ohio law against discrimination requires that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law. Regardless of your marital status you may apply for credit in your name alone. TODAY'S DATE: TYPE OF APPLICATION: ( Individual, relying only on my income ( Additional Party* CREDIT UNION ACCOUNT NO. Purpose of Loan Amount of LoanNo. Mos. ( Secured Credit - Collateral: New/Used Auto - Make Year Cost/Value$ Shares in Account Nos. $ Other Collateral: APPLICANT( CO-APPLICANT ( SPOUSE ( GUARANTORName NameAccount NumberDrivers License No.Social Security No.Account NumberDrivers License No.Social Security No. Birth DateHome PhoneBusiness PhoneBirth DateHome PhoneBusiness Phone Present Address (Street, City, State, Zip)Years at this addressPresent Address (Street, City, State, Zip)Years at this address (Own ( Rent ( Own ( RentLast Previous Address (Street, City, State, Zip)Years at this addressLast Previous Address (Street, City, State, Zip)Years at this address (Own ( Rent ( Own ( RentComplete for joint credit, secured credit or if you live in a community property state: ( Married ( Separated ( Unmarried (Single, Divorced, Widowed)Complete for joint credit, secured credit or if you live in a community property state: ( Married ( Separated ( Unmarried (Single, Divorced, Widowed)Number of Dependents other than listed by Co-Applicant (exclude self)AgesNumber of Dependents other than listed by Co-Applicant (exclude self)AgesEmployment and Income InformationEmployment and Income InformationName and Address of EmployerName and Address of Employer PositionSupervisorPositionSupervisor Starting DateSelf Employed ( Yes ( NoType of BusinessStarting DateSelf Employed ( Yes ( NoType of BusinessMilitary: Is duty station transfer expected During next 12 mos.? ( Yes ( NoMilitary: Is duty station transfer expected During next 12 mos.? ( Yes ( NoEmployment Income ( Gross ( Net $ perOther Income $ perSourceEmployment Income ( Gross ( Net $ perOther Income $ perSourceIf employed in current position less than three years, complete the following:If employed in current position less than three years, complete the following:Previous Employer Name & AddressStarting DatePrevious Employer Name & AddressStarting Date Ending DateEnding Date PositionSupervisorPositionSupervisor THESE QUESTIONS APPLY TO BOTH APPLICANT & CO-APPLICANTIf a "YES" answer is given to a question, explain on an attached sheetApplicantCoApplicantYesNoYesNoHave you any outstanding judgements against you?In the last 14 years, have you filed a petition for relief under the bankruptcy code?Have you had property foreclosed upon or given title or deed in lieu thereof, in the last 7 years?Are you a party in a law suit?Are you other than a U.S. Citizen or Permanent Resident Alien?Is your income likely to be reduced in the future?Are you a co-signer/guarantor on any loan? If yes, answer next two questions. For whom (name of others obligated on loan): To whom (name of creditor):REFERENCESREFERENCESName & Address of Nearest Relative not living with youRelationshipName & Address of Nearest Relative not living with youRelationship Home PhoneHome PhonePLEASE CONTINUE ON REVERSE SIDE ( OUTSTANDING DEBTS (List everything - attach other sheets if necessary)A=Applicant C=Co-ApplicantCreditor Name & AddressAccount NumberPresent BalanceMonthly PaymentNumber of Months Past Due( A ( C Rent( A ( C Home Mortgage Market Value $( A ( C Second Mortgage( A Real Estate ( C Other Than Home( A Alimony and ( C Child Support( A ( C Auto Loan Make Year( A ( C Auto Loan Make Year( A ( C Credit Union( A ( C Banks( A ( C Banks( A ( C Banks( A ( C Banks( A ( C Credit Card( A ( C Credit Card( A ( C Credit Card( A ( C Credit Card( A ( C Other( A ( C Other( A ( C Other( A ( C OtherTOTALSList any names under which credit has previously been received. I (we) certify that all information contained in this application is correct to the best of my (our) knowledge and I (we) have disclosed all outstanding obligations currently owed. I (we) hereby give the Credit Union authorization to check on my (our) credit; employment history; obtain a credit report; and to answer questions about our credit experience with you. (I (we) understand that it may be a federal crime punishable by fine or imprisonment (or both) to knowingly make any false statements concerning any of the above facts as applicable under the provisions of the United States Criminal Code.Applicant's Signature Date (Co-Applicant's Signature Date ( CREDIT COMMITTEE/LOAN OFFICER ACTION Loan Officer: I approve the loan as submitted. Loan referred to Credit Committee Reason LO Signature: Date: Credit Committee: We approve the loan as submitted. Date___________________ We reject the loan as submitted. The following counter offer will be made to the applicant and if accepted, we approve the loan. 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