Austin City Employees Credit Union                   Signature Loan Application

711 4^th Ave NE, Austin, MN 55912                                   

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

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

                 The information on this application will be used for all credit requests made by the applicant.

                 Complete all the required information and sign where indicated.

         Mail to the Credit Union with currents paycheck stub(s) as proof of employment.

                 GENERAL

Applicants Name			Account Number
Street Address	City, State, Zip		How Long
Previous Address (If less than 5 years)	City, State, Zip		How Long
Social Security Number	Date of Birth	Driver’s License        State of Issue
Home Phone  Number (          )	Work Phone Number (          )	Dependants (excluding self) No.                   Ages
Applicant’s Parents	Full Address		Phone Number
Personal Reference (Not Related)	Full Address		Phone Number
Personal Reference (Not Related)	Full Address		Phone Number

 

                 EMPLOYMENT

Present Employer		Address (Street, City, State, Zip)
Date Employed	Annual Gross Salary $	Job Title	Supervisor	Supervisor Phone No.
Previous Employer		Address (Street, City, State, Zip)		Dates Employed From:            To:

 

                 THIS APPLICATION IS FOR A: (Notice: Married applicants may apply for an                  individual account)

____ Individual Account____ Joint Account with my spouse ____ Joint Account with someone other than my spouse

                                                                                                                                       

                 SPOUSE /CO-APPLICANT

                 Complete this section if: (1) this is to be a joint account with your spouse, (2) your spouse will use this                  account, (3) you live in a community property state (Arizona, California, Idaho, Louisiana, Nevada, New                  Mexico, Puerto Rico, Texas, Washington, or Wisconsin) or (4) you are relying on your spouse’s income in                  applying for this account.  This section must be completed about your co-applicant if this is for a joint                  account with someone other than your spouse.

Name		Social Security Number			Date of Birth	Account Number
Street Address		City, State, Zip					How Long
Present Employer	Job Title		Supervisor			Supervisor Phone
Address (Street, City, State, Zip)	Date Employed			Annual Salary $
Co-Applicants Parents	Full Address					Phone Number
Personal Reference (not related)	Full Address					Phone Number

 

                 OTHER INCOME

                 You need not reveal income from alimony, child support or separate maintenance payments unless you                  want us to consider it in this application.

(1) Source of Other Income (Explain)		Other Income $	(2) Source of Other Income (Explain)	Other Income $
Savings at Other: ___ Bank ___ Credit Union ___ S & L   $	Name, City & State			Balance $

 

                

                 CREDIT REFERENCES

Name of Creditor	Name on Account	Account Number	Telephone
Name of Creditor	Name on Account	Account Number	Telephone

 

 PERSONAL STATEMENT OF NET WORTH

(And Complete Disclosure of all Obligations)

                 I OWN ASSETS OF:

Cash on Hand and in Bank	$	Other Real Estate (market value)	$
Savings Accounts (credit union & other)	$	Other Assets: (itemize below)
Stocks and Bonds (market value)	$	1.	$
Household Goods (market value)	$	2.	$
Home (market value)	$	3.	$
Boat, Motor, Trailer, Camper (market value)	$	4.	$
Automobiles (market value)	$	Total Assets	$

 

                 I OWE DEBTS OF: (all indebtedness must be listed below.  If no write “NONE”                  across the page)

TO WHOM OWED-NAME AND ADDRESS		PURPOSE OF DEBT	BALANCE OWING	MONTHLY PAYMENT
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
I/We hereby state that my total indebtedness on this date does not exceed:		TOTAL=	$	$
My Total Assets $	Less My Total Debts $		Equal (Net Worth) $

 

                 Have you ever filed a petition for Chapter 13                  ___ yes ___ no            Year Filed ________

                 Have you ever filed a petition for bankruptcy                 ___ yes ___ no            Year Filed ________

                 Are any suits pending, judgments unsatisfied, alimony or maintenance against you?          ___ yes ___ no

                 Ever had any auto, furniture or other property repossessed?                                               ___ yes ___ no

                 Do you have any past due bills?                                                                                         ___ yes ___ no                            

                 Note: If you answered “yes” to any of the above questions, please explain on a separate sheet.

 

                 Are you a co-maker or endorser on another person’s note or loan?    ___ yes ___ no  Amount $________

                 Name of other person: _______________________________________________Amount $________

 

 

                  X__________________________                    X____________________________

                 Signature                                Date                                          Joint Signature                     Date