Use this convenient application to apply for a
Credit Union loan. Simply print this form
on your printer by pressing print in your browser, complete the form and
return it to
your local CCCU office. A Credit Union loan officer
will be in contact with you.
Purpose of loan ________________________________________________
Amount requested $ _________________Collateral ____________________
Name (last, first, initial)__________________________________________
Social Security No. _______________________
Date of birth_______________________ No. of dependents__________
Address-(street, city, state, zip)
__________________________________________________________
Years there__________ Home phone____________________________
Present Employer___________________________________________
Address___________________________________________________
Position___________________________ Date hired________________
Business phone______________________
Gross Monthly salary_________________ Other income*___________
Monthly Rent/Mortgage payment $_________________
CO-APPLICANT (optional)
Spouse Co-SignerJoint
Owner
Name (last, first, initial)_______________________________________
Social Security No. __________________________________________
Date of birth_______________________ No. of dependents__________
Address (street, city, state, zip)
__________________________________________________________
Present Employer __________________________________________
Address___________________________________________________
Position_______________________________ Date hired____________
Business phone______________________
Monthly salary_________________ Other income*___________
A convenient time to call me: __________ (time) at _________ (phone)
or by mailing to my home address.
*Notice:
Alimony, child support or separate maintenance income need not be
revealed if you do not wish to have it considered.
The
information in this application is true and may be relied on in
evaluating this loan
request. You are authorized to check my credit and employment plus
answer any
questions regarding my credit experience with you. I 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 US Criminal Code.
Mail to: Citizens
Community Credit Union, PO Box 1000, Devils Lake, ND 58301
Fax to: 701-662-8796
