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Loan Application

Request Date: April 17, 2014, 7:13 PM CDT

Please contact the credit union at (605)448-2292 or (866)322-2328 if you have any questions about filling out this loan application.

Account #:
Loan Purpose: *
Amount Requested: $ *
Payment Amount or Number of Payments: *

 

Primary Applicant
First Name: *
Middle Name:
Last Name: *
Street Address: *
Street Address:
City: *
State: *
Zip: *
Years at this Address:
Do you Own or Rent: Own     Rent     Other    
If Other Specify:
Home Phone: - - *
Date of Birth: / / *
Social Security Number: - - *
Email Address:
Employer: *
Work Phone: - -
Years at this Employer:
Gross Salary per Month: *

Alimony, child support, and separate maintenance income need not be declared if you do not wish to have it considered for this application.
Other Income: Monthly Amount Source
Other Income #1:
Other Income #2:
Other Income #3:

 

Secondary Applicant
First Name:
Middle Name:
Last Name:
Street Address:
Street Address:
City:
State:
Zip:
Years at this Address:
Do you Own or Rent: Own     Rent     Other    
If Other Specify:
Home Phone: - -
Date of Birth: / /
Social Security Number: - -
Email Address:
Employer:
Work Phone: - -
Years at this Employer:
Gross Salary per Month:

Alimony, child support, and separate maintenance income need not be declared if you do not wish to have it considered for this application.
Other Income: Monthly Amount Source
Other Income #1:
Other Income #2:
Other Income #3:

 

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I am interested in:
Disability Insurance
Credit Life Insurance

Authorization Notice: By submitting this application to the credit union, you certify that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of your debts and obligations. You authorize the credit union to obtain credit reports in connection with this application for credit and for any, update renewal or extension of the credit received. If you request, the credit union will provide you with the name and address of any credit bureau from which it received your credit report. You understand that the credit union will rely on both the representations you make in this application and the contents of any credit report it obtains when deciding whether to grant the credit requested. You agree to immediately notify us of changes to any of the information you have provided in this application. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on applications made to Credit Unions or State Chartered Credit Unions insured by NCUA.