LOAN APPLICATION INFORMATION CONCERNING CREDIT INSURANCE (Check One or Both) CREDIT INSURANCE IS AVAILABLE ON LOANS MADE TO CREDIT UNION MEMBERS. INSURANCE IS VOLUNTARY AND NOT REQUIRED TO OBTAIN CREDIT. IF YOU WOULD LIKE YOUR LOAN PROTECTED BY CREDIT INSURANCE CHECK BELOW. YES SINGLE GROUP CREDIT LIFE YES JOINT GROUP CREDIT INSURANCE YES GROUP CREDIT DISABILITY INSURANCE NO NO NO THE CREDIT UNION WILL DISCLOSE THE COST OF THIS VOLUNTARY INSURANCE TO YOU IF YOU CHECKED YES. A SEPARATE ELECTION DISCLOSING THE TERMS AND CONDITITIONS OF THE CREDIT INSURANCE MUST BE SIGNED FOR THE COVERAGE TO BE EFFECTIVE. NOTICE: The information below and on the reverse will be used to evaluate your credit request. If this will be a joint account the co-applicant must sign where indicated. Married persons may apply for an individual account. This account will be: INDIVIDUAL ACCOUNT JOINT ACCOUNT WITH SPOUSE JOINT ACCOUNT OTHER THAN SPOUSE OPEN-END CLOSED-END LOAN AMOUNT REQUESTED $ ESTIMATED REPAYMENT PERIOD MONTHS REQUESTED PERIODIC PAYMENT $ PURPOSE OF LOAN COLLATERAL APPLICANT  APPLICANT NAME DATE OF BIRTH  PRESENT ADDRESS (Street - City - State - Zip) COUNTY OWN   RENT       YEARS AT THIS ADDRESS   PREVIOUS ADDRESS(ES) LAST FIVE YEARS OWN   RENT     YEARS AT THIS ADDRESS   HOME PHONE BUSINESS PHONE / EXT.  (     ) (     )  ACCOUNT NUMBER  SOCIAL SECURITY NUMBER  DRIVER'S LICENSE NUMBER / STATE     NUMBER OF DEPENDENTS. EXCLUDE SELF ANY LISTED BY CO-APPLICANT   AGES  ANSWER IF YOU LIVE IN A COMMUNITY PROPERTY STATE. THIS WILL BE JOINT ACCOUNT OR SECURED: MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed) EMPLOYMENT / INCOME  PRESENT EMPLOYER      EMPLOYER ADDRESS (Street - City - State - Zip)  JOB TITLE / GRADE SUPERVISOR. SUPERVISOR PHONE  DATE EMPLOYED TYPE OF BUSINESS SELF-EMPLOYED YES        NO   IS MILITARY DUTY STATION TRANSFER  EXPECTED WITHIN NEXT YEAR? YES        NO  WHERE ETS DATE EMPLOYMENT INCOME OTHER INCOME SOURCE OF OTHER INCOME $ NET GROSS $                             PER   *You need not reveal income from alimony, child support, or separate maintenance payments unless you want it considered in evaluating this credit application. PREVIOUS EMPLOYER(S) NAME ADDRESS STARTING DATE ENDING DATE ASSETS  CURRENT DEPOSITS AT OTHER FINANCIAL INSTITUTIONS ACCOUNT NUMBER CHECKING  SAVINGS  NAME AND ADDRESS OF INSTITUTION ACCOUNT NUMBER CHECKING  SAVINGS    NAME AND ADDRESS OF INSTITUTION ACCOUNT NUMBER CHECKING  SAVINGS  NAME AND ADDRESS OF INSTITUTION  DESCRIPTION OF CLEAR TITLE ASSETS (CAR, PROPERTY) VALUE $ Pledged As Collateral YES  NO  (OTHER ASSETS) $ Pledged As Collateral YES  NO OTHER  Co-Applicant  Spouse  APPLICANT NAME DATE OF BIRTH  PRESENT ADDRESS (Street - City - State - Zip) COUNTY OWN   RENT       YEARS AT THIS ADDRESS   PREVIOUS ADDRESS(ES) LAST FIVE YEARS OWN   RENT     YEARS AT THIS ADDRESS   HOME PHONE BUSINESS PHONE / EXT.  (     ) (     )  ACCOUNT NUMBER  SOCIAL SECURITY NUMBER  DRIVER'S LICENSE NUMBER / STATE     NUMBER OF DEPENDENTS. EXCLUDE SELF ANY LISTED BY CO-APPLICANT   AGES  ANSWER IF YOU LIVE IN A COMMUNITY PROPERTY STATE. THIS WILL BE JOINT ACCOUNT OR SECURED: MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed) EMPLOYMENT / INCOME  PRESENT EMPLOYER      EMPLOYER ADDRESS (Street - City - State - Zip)  JOB TITLE / GRADE SUPERVISOR. SUPERVISOR PHONE  DATE EMPLOYED TYPE OF BUSINESS SELF-EMPLOYED YES        NO   IS MILITARY DUTY STATION TRANSFER  EXPECTED WITHIN NEXT YEAR? YES        NO  WHERE ETS DATE EMPLOYMENT INCOME OTHER INCOME SOURCE OF OTHER INCOME $ NET GROSS $                             PER   *You need not reveal income from alimony, child support, or separate maintenance payments unless you want it considered in evaluating this credit application. PREVIOUS EMPLOYER(S) NAME ADDRESS STARTING DATE ENDING DATE ASSETS  CURRENT DEPOSITS AT OTHER FINANCIAL INSTITUTIONS ACCOUNT NUMBER CHECKING  SAVINGS  NAME AND ADDRESS OF INSTITUTION ACCOUNT NUMBER CHECKING  SAVINGS    NAME AND ADDRESS OF INSTITUTION ACCOUNT NUMBER CHECKING  SAVINGS  NAME AND ADDRESS OF INSTITUTION  DESCRIPTION OF CLEAR TITLE ASSETS (CAR, PROPERTY) VALUE $ Pledged As Collateral YES  NO  (OTHER ASSETS) $ Pledged As Collateral YES  NO   APPLICANT CO-APPLICANT Have you ever filed a petition for bankruptcy (Personal or Business)? YES  NO YES  NO Have you ever filed a petition for Chapter 13 Bankruptcy? YES  NO YES  NO Are any suits pending, judgments filed, alimony or support awards against you? YES  NO YES  NO Have you ever had any auto, furniture, or any property repossessed? YES  NO YES  NO Are you a party in a lawsuit? YES  NO YES  NO Do you have any outstanding judgments? YES  NO YES  NO Is any income you have shown likely to reduce in the next two years? YES  NO YES  NO Are you a co-maker or co-signer on any loan? If so, whom? YES  NO YES  NO NAME OF OTHERS OBLIGATED ON LOAN AND NAME OF CREDITOR YES  NO YES  NO IF ANY YES ANSWERS TO QUESTIONS, EXPLAIN: Are you a United States Citizen? YES  NO YES  NO .............IF NO LIST STATUS                 OUTSTANDING DEBITS AND OBLIGATIONS - LIST EVERYTHING OWED CHECK ONE OR MORE NAME AND ADDRESS OF CREDITOR                            ACCT. NO. PAST DUE ORIGINAL AMOUNT BALANCE MONTHLY PAYMENT     HOUSE PAYMENT OR RENT             HOUSE PAYMENT OR RENT             AUTO LOAN             AUTO LOAN             DEPARTMENT STORES                                         CHILD SUPPORT             CHILD CARE             CREDIT CARDS                                                       LOAN PAYMENTS                                         MISC. EXPENSES (UTILITIES, TELEPHONE, INSURANCE, ECT.)         TOTAL $ $ $ REFERENCES NAME AND ADDRESS NEAREST RELATIVE NOT LIVING WITH YOU RELATIONSHIP PHONE NAME AND ADDRESS NEAREST RELATIVE NOT LIVING WITH YOU RELATIONSHIP PHONE NAME AND ADDRESS OF PERSONAL FRIEND PHONE NAME AND ADDRESS OF PERSONAL FRIEND PHONE Signatures You agree that everything slated in this application is correct to the best of you knowledge. The credit union is authorized to investigate your credit worthiness, employment history and to obtain a credit report and to answer questions about their credit experience with you. You understand that any false or misleading statements in your application may cause any loan or extension to be in default. Borrower hereby grants lender permission to verify or share with third parties any information concerning borrower contained in lender's files if deemed necessary by lender, including the sharing of information with credit reporting agencies, responses to bona fide inquiries from other lenders and if necessary for the enforcement and protection of lender's rights under this transaction and for fraud prevention. X __________________________________________ X __________________________________________   Applicants Signature                                 Date   Other Signature                                 Date  CREDIT COMMITTEE/LOAN OFFICER ACTION Loan Officer: Approved Referred to C.C. Reason ________________________________________________________________________ LO Signature ________________________________________________ Credit Committee: Date ________________________ Approved Rejected Signature ________________________________________________ Signature ________________________________________________ Signature ________________________________________________ Specific Reasons for rejection ______________________________________________________________________   Outside information considered No Yes (describe)________________________________________________ Line of Credit Limit $ ________________________ Conditions, if any: ________________________ You Must Print, Sign, and Return to Credit Union

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