Evansville Federal Credit Union Loan Application


* indicates a required field


Is this an individual or joint loan?


Property and Loan Info

*Amount Requested
*Collateral
Purpose of Loan


Explain:

Primary Borrower Information

*Name (First M. Last)
*Date of Birth (mm/dd/yyyy):
Member Number:
*Social Security Number
*Level of Education:
*Number of Dependents:
Ages of Dependents: #1 #2
#3 #4
#5 #6
*Driver's License Number: State
*E-mail

*Current Address
*City, State, Zip ,
*Current Home Phone Number:

*Current Employer:
*Current Job Title:
*Current Work Address:
*City, State, Zip ,
*Current Work Phone Number:

Former Address:
City, State, Zip ,
Former Home Phone Number:

Former Employer:
Former Job Title:
Former Address:
City, State, Zip ,
Former Work Phone Number:

Joint Borrower Information

*Name (First M. Last)
*Date of Birth (mm/dd/yyyy):
Member Number:
*Social Security Number
*Level of Education:
*Number of Dependents:
Ages of Dependents: #1 #2
#3 #4
#5 #6
*Driver's License Number: State
*E-mail

*Current Address
*City, State, Zip ,
*Current Home Phone Number:

*Current Employer:
*Current Job Title:
*Current Work Address:
*City, State, Zip ,
*Current Work Phone Number:

Former Address:
City, State, Zip ,
Former Home Phone Number:

Former Employer:
Former Job Title:
Former Address:
City, State, Zip ,
Former Work Phone Number:

Information For Government Monitoring Purposes

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)
Borrower I do not wish to furnish this information

Ethnicity: Hispanic or Latino Not Hispanic or Latino

Race: American Indian or Alaska Native Asian Black or African American
  Native Hawaiian or Other Pacific Islander White  

Sex: Female Male

Co-Borrower I do not wish to furnish this information

Ethnicity: Hispanic or Latino Not Hispanic or Latino

Race: American Indian or Alaska Native Asian Black or African American
  Native Hawaiian or Other Pacific Islander White  

Sex: Female Male

This application was taken by:
Face-to-face interview
Mail
Telephone
Internet


Monthly Income

Borrower Joint Borrower Total
Base Employ Income:
Overtime/Bonus:
Dividends/Interest:
Rental Income:
Other:
Notice:
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation
*Total:

Description ASSETS VALUES
Checking account
 
Stock, Bonds, or Mutuals
 
Real Estate
 
Retirement Accounts
 
Autos
 
Other
 
*Total Assets
Description LIABILITIES BALANCE
Real Estate
 
 
Autos
 
 
Credit Cards
 
 
Others
 
*Total Liabilities
 
*Net Worth (assets - liabilities)

Other Questions
(Check box for 'yes' or leave blank for 'no')
Borrower
Are there any judgments against you?
Have you been declared bankrupt within the past 7 years?
Have you had property foreclosed upon or given title/deed in lieu thereof in the last 7 years?
Are you a party to a law suit?
Are you obligated to pay alimony, child support, or separate maintenance?
Is any of the down payment borrowed?
Are you a co-maker or endorser on a note?
Joint Borrower
Are there any judgments against you?
Have you been declared bankrupt within the past 7 years?
Have you had property foreclosed upon or given title/deed in lieu thereof in the last 7 years?
Are you a party to a law suit?
Are you obligated to pay alimony, child support, or separate maintenance?
Is any of the down payment borrowed?
Are you a co-maker or endorser on a note?

Additional Comments


* indicates a required field

    Reset