General Information

Account/Loan

Joint
Individual

(If Joint, the co-applicant section has the same required fields as the primary applicant.)

Amount Requested $

Purpose/Collateral: *

Credit Limit Requested $

Primary Applicant

Account Number *

First Name *

Middle Name

Last Name *

Social Security Number (TIN) *

Date of Birth *

Email Address

Home Phone

Cell Phone

Business Phone/Ext

Driver License Number *

Drivers License State *

Ages of Dependents

Home Address

Address 1 *

Address 2

City *

State *

ZIP Code *

Residence Type

Own
Rent

Time at Current Residence

Years

Months

Mortgage/Rent Owed To

Mortgage Balance $

Monthly Payment

Interest Rate %

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

Marital Status

Married
Separated
Unmarried

Primary Applicant Employment/Income

Employment Status

Full Time
Part Time
Retired

Job Start Date

Employer Name

Employer Phone

Employer Address

Employer City

Employer State

Employer ZIP Code

Job Title

Gross Salary

Per

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.

Other Income $

Per

Other Income Source

Previous Employer (if employed less than two years)

Previous Employer Name

Previous Employer Phone

Previous Employer Address

Previous Employer City

Previous Employer State

Previous Employer ZIP Code

Previous Employer Start Date

Previous Employer End Date

Military

Is Duty Station Transfer Expected During Next Year?

Where

Ending/Separation Date

Primary Applicant Reference (Nearest Relative Not Living With You)

Primary Applicant Reference First Name

Primary Applicant Reference Last Name

Primary Applicant Reference Address

Primary Applicant Reference City

Primary Applicant Reference State

Primary Applicant Reference City ZIP Code

Primary Applicant Reference Relationship

Primary Applicant Reference Phone

CoApplicant

Co-Applicant Type *

Spouse
Guarantor
Other

Co-Applicant Account Number *

Co-Applicant First Name *

Co-Applicant Middle Name

Co-Applicant Last Name *

Co-Applicant Social Security Number (TIN) *

Co-Applicant Date of Birth *

Co-Applicant Email Address

Co-Applicant Home Phone

Co-Applicant Cell Phone

Co-Applicant Business Phone/Ext

Co-Applicant Driver License Number *

Co-Applicant Driver License State *

Co-Applicant Ages of Dependents

Co-Applicant Home Address

Co-Applicant Address 1 *

Co-Applicant Address 2

Co-Applicant City *

Co-Applicant State *

Co-Applicant ZIP Code *

Co-Applicant Residence Type

Own
Rent

Co-Applicant Time at Current Residence

Years

Months

Co-Applicant Mortgage/Rent Owed To

Co-Applicant Mortgage Balance $

Co-Applicant Monthly Payment $

Co-Applicant Interest Rate %

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

Co-Applicant Marital Status

Married
Separated
Unmarried

Co-Applicant Employment/Income

Co-Applicant Employment Status

Full Time
Part Time
Retired

Co-Applicant Job Start Date

Co-Applicant Present Employer Name

Co-Applicant Present Employer Phone

Co-Applicant Present Employer Address

Co-Applicant Present Employer City

Co-Applicant Present Employer State

Co-Applicant Job Title

Co-Applicant Gross Salary $

Per

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.

Co-Applicant Other Income $

Per

Co-Applicant Other Income Source

Co-Applicant Previous Employer (if employed less than two years)

Co-Applicant Previous Employer Name

Co-Applicant Previous Employer Phone

Co-Applicant Previous Employer Name

Co-Applicant Previous Employer Address

Co-Applicant Previous Employer City

Co-Applicant Previous Employer State

Co-Applicant Previous Employer ZIP Code

Co-Applicant Previous Employer Job Start Date

Co-Applicant Previous Employer Job End Date

Co-Applicant Military

Is Duty Station Transfer Expected During Next Year?

Where

Ending/Separation Date

Co-Applicant Reference

Co-Applicant Reference First Name

Co-Applicant Reference Last Name

Co-Applicant Reference Address

Co-Applicant Reference City

Co-Applicant Reference State

Co-Applicant Reference State ZIP Code

Co-Applicant Reference Relationship

Co-Applicant Reference Phone

State Law Notices

Notice to Nebraska Residents: A credit agreement must be in writing to be enforceable under Nebraska law. To protect you and us from any misunderstandings or disappointments, any contract, promise, undertaking, or offer to forebear repayment of money or to make any other financial accommodation in connection with this loan of money or grant or extension of credit, or any amendment of, cancellation of, waiver of, or substitution for any or all of the terms or provisions of any instrument or document executed in connection with this loan of money or grant or extension of credit, must be in writing to be effective.

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

Notice to Wisconsin Residents: (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.

Acknowledgement

By submitting this application, you promise that everything you have stated in this application is correct to the best of your knowledge. 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, increase, renewal, extension, or collection of the credit received and for other accounts, products, or services we may offer you or for which you may qualify. 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 crime to willfully and deliberately provide incomplete or incorrect information in this application.

First Priority Credit Union Loan Application

Instructions

General Information

Primary Applicant

CoApplicant

State Law Notices

Acknowledgement