Crouse FCU

Will this loan be a single or joint application?*
Single
Joint

VIN #

Make

Model

Year

Mileage

Loan Term (in months)

Do you want Credit Disability Insurance in connection with this loan?

Yes

Do you want Credit Life Insurance in connection with this loan?

Yes

Driver's License No.

Driver's License State

Previous Address (if less than 2 years at present address)

Phone (Best contact phone #)

Complete for joint credit, secured credit, or if you live in a community property state
Married
Separated
Unmarried (single-divorced-widowed)

Previous employer (if less than 2 years at present employer)

Residence
Own
Rent
Lives with relatives

Present Mortgage Co., Landlord, or Relative

Monthly Mortgage/Rent Payment (includes taxes and insurance)

Current Value * If you own your home, what is the current value?

Is the property described your principal dwelling?
Yes
No

Any proceeds for a Refinanced Mortgage, Home Equity, or Home Improvement?
Yes
No

Is the property described listed as the applicant's address in the "Personal Information" section?
Yes
No

Is anyone other than your spouse a part owner of your home?
Yes
No

Have you ever had a car or other personal property repossessed by a dealer or finance company, filed for bankruptcy, or been a party to a wage assignment or collection suit, or have you ever been declined on a loan application with this credit union? *
Yes
No

Reference

Name of nearest relative not living with you

Relatives Address

Address 2

City

State

Zip Code

Relationship

Phone

Additional Questions

Please answer the following questions with Capital Letters.

Are you a US citizen or permanent resident alien?

Do you have any outstanding judgments?

Is your income likely to decline in the next two years?

Are you a co-maker, co-signer, or guarantor on any loan not listed?

Are you a student or do you have a work visa?

Have you filed for bankruptcy or had a debt adjustment plan confirmed under chapter 13?

Have you had property foreclosed upon or given a deed in lieu of foreclosure in the last 7 years?

Are you a party in a lawsuit?

For whom?

To whom?

Home equity information

Share draft or checking amount

Name of depository

Address of depository

Savings amount

Name of depository

Address of depository

Driver's License No.

Driver's License State

Previous Address (if less than 2 years at present address)

Phone (Best contact phone #)

Complete for joint credit, secured credit, or if you live in a community property state
Married
Separated
Unmarried (single-divorced-widowed)

Previous employer (if less than 2 years at present employer)

Residence
Own
Rent
Lives with relatives

Present Mortgage Co., Landlord, or Relative

Monthly Mortgage/Rent Payment (includes taxes and insurance)

Current Value * If you own your home, what is the current value?

Reference

Name of nearest relative not living with you

Relatives Address

Address 2

City

State

Zip Code

Relationship

Phone

Co-Applicant Home equity information

Share draft or checking amount

Name of depository

Address of depository

Savings amount

Name of depository

Address of depository

Additional Questions

Please answer the following questions with Capital Letters.

Are you a US citizen or permanent resident alien?

Do you have any outstanding judgments?

Is your income likely to decline in the next two years?<

Are you a co-maker, co-signer, or guarantor on any loan not listed?

Are you a student or do you have a work visa?

Have you filed for bankruptcy or had a debt adjustment plan confirmed under chapter 13?

Have you had property foreclosed upon or given a deed in lieu of foreclosure in the last 7 years?

Are you a party in a lawsuit?

Assets and Debts

List your debts.

Debt 1

Debt 1 creditor

Debt 1 original balance

Debt 1 present balance

Debt 1 monthly payment

Debt 1 Owner
Applicant
Co-Applicant

Debt 2

Debt 2 creditor

Debt 2 original balance

Debt 2 present balance

Debt 2 monthly payment

Debt 2 Owner
Applicant
Co-Applicant

Debt 3

Debt 3 creditor

Debt 3 original balance

Debt 3 present balance

Debt 3 monthly payment

Debt 3 Owner
Applicant
Co-Applicant

Debt 4

Debt 4 creditor

Debt 4 original balance

Debt 4 present balance

Debt 4 monthly payment

Debt 4 Owner
Applicant
Co-Applicant

Debt 5

Debt 5 creditor

Debt 5 original balance

Debt 5 present balance

Debt 5 monthly payment

Debt 5 Owner
Applicant
Co-Applicant

Debt 6

Debt 6 creditor

Debt 6 original balance

Debt 6 present balance

Debt 6 monthly payment

Debt 6 Owner
Applicant
Co-Applicant

Do you agree with the above terms and conditions?
Yes

Signature (type your full name)

Date

Co-Applicant

Do you agree with the above terms and conditions?
Yes

Signature (type your full name)

Date