Page Title

Austin City Employees Credit Union Secured Loan Application

711 4^th Ave NE, Austin, MN 55912

(507) 433-6580 or (877) 918-1178 Toll Free

HOW TO APPLY: PRINT THIS APPLICATION, COMPLETE & MAIL TO THE CREDIT UNION!

Please complete all pages of the application

Sign on last page where indicated

Return completed application and current paycheck stub(s) to the Credit Union

An incomplete or unsigned application may delay processing

____________________________________________________________________________________________________

Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:

1. you live in or on 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 Other section to the extent possible about the person on whose payments you are relying.

Joint Credit: If you are applying with another person, complete the Applicant and Other sections.

Guarantor: Complete the Other section if you are guarantor on the account/loan.

____ Individual____ Joint Amount Requested $________________Purpose/Collateral ________________

Repayment: ____ Payroll Deduction ____ Cash ____ Military Allotment ____ Automatic Payment

__________________________________________________________________________________________________ PAYMENT PROTECTION:

___ Single Credit Disability Insurance ____ Single Credit Life Insurance____ Joint Credit Life Insurance

Check coverage(s) desired. The Credit Union will disclose the cost of this voluntary insurance to you. A separate insurance election which disclosed the terms and conditions must be signed for coverage to become effective.

Applicant

Other: ____ Co-Applicant ____ Spouse

____ Guarantor

Name

Name

Account Number

Social Security Number

Account Number

Social Security Number

Driver’s License/State

List Ages of Dependents(exclude self)

Driver’s License

List Ages of Dependents(exclude self)

Birth Date

Home Phone

Business Phone

Birth Date

Home Phone

Business Phone

Present Address

___ Own   ___ Rent

Present Address

___ Own   ___ Rent

Years at Address

Years at Address

Previous Address

___ Own   ___ Rent

Previous Address

___ Own   ___ Rent

Years at Address

Years at Address

Complete for Joint Credit, Secured Credit or if you live in a Community Property State:

___ Married   ___ Separated   ___ Unmarried

Complete for Joint Credit, Secured Credit or if you live in a Community Property State:

___ Married   ___ Separated   ___ Unmarried

Employment/Income: Name and Address of Employer

Employment/Income: Name and Address of Employer

Title

Start Date

Hours at Work

Title

Start Date

Hours at Work

Supervisor’s Name

If Self Employed, Type of Business

Supervisor’s Name

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.

Notice: Alimony, Child Support, or Separate maintenance income need not be revealed if you do not choose to have it considered.

Employment Income

$____________ per________

___ Net    ___ Gross

Other Income

$___________ per___________

Source:

Employment Income

$____________ per__________

___ Net   ___ Gross

Other Income

$____________ per__________

Source:

Military: is duty station transfer expected during next year? ___ yes   ___ no

Where:                                           Ending/Separation Date

Military: is duty station transfer expected during next year?

___ yes   ___ no

Where:                                          Ending/Separation Date

Previous Employer Name and Address if employed less than five years.

Starting Date

Previous Employer Name and Address if employed less than five years.

Starting Date

Ending Date

Ending Date

Applicant Reference Other Reference

Name of nearest relative not living with you

Relationship

Name of nearest relative not living with you

Relationship

Address

Telephone

Address

Telephone

What You Owe

Creditor Name

Interest Rate

Present Balance

Monthly Payment

Applicant

Other

__ Rent __ Own

$

$

Loans

$

$

$

$

$

$

Credit Card(s)

$

$

$

$

$

$

Other

$

$

$

$

Totals

$

$

What You Own

List Location of Property or Financial Institution

Market Value

Pledged as Collateral for Another Loan?

Owned By

Applicant/Other

Home

$

Yes

No

Auto

$

Yes

No

Savings

$

Yes

No

Checking

$

Yes

No

Other (describe)

$

Yes

No

Other Information About You

If you answer “yes” to any question other than #1, explain on an attached sheet

Applicant Other

Yes | No Yes | No

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1. Are you a U.S. Citizen or permanent resident alien? ___ | ___ ___ | ___

2. Do you currently have any outstanding judgments or have ever filed for

Bankruptcy, had a debt adjustment plan confirmed under Chapter 13,

had property foreclosure upon or repossessed in the last 7 years, or

been a party to a lawsuit? ___ | ___ ___ | ___

3. Is your income likely to decline in the next two years? ___ | ___ ___ | ___

4. Are you a co-maker or guarantor on any loan above? ___ | ___ ___ | ___ For whom? (Name of Others Obligated on Loan) To Whom? (Name of Creditor)

__________________________________________________________________________________________________

State Law Notices

Ohio Residents Only: The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy 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.

Wisconsin Residents Only: (1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

_________________________________________________________ Signature for Wisconsin Residents Only Date

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, renewal or extension 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 on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.

__________________________________ _________________________________

Applicants Signature Date Other Signature Date

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