Loan Application

Effective October 1, 2003

In accordance with section 326 of the USA Patriot Act, Chadron Federal CU is required by Federal law to obtain, verify, and record information that identifies each person who opens an account or is being added as a signatory to a new or existing account. In some cases, identification will be requested for those banking with us prior to the effective date of the customer identification requirements because original documentation was not obtained with the opening of the accounts.

What this means for you:

When you open an account or are going to be added as a signatory to an account, we will ask for you name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

* Required Fields

Purpose of Loan:

Amount Requested:

Applying for a Joint Account:

Yes

This application initiates the loan process. Final signature(s) will be required to advance funds, including signatures for joint applicants. We will contact you the next business day.

PLEASE TELL US ABOUT YOURSELF (PRIMARY BORROWER)

Full Name:

Street Address:

Street Address 2:

City:

State:

ZIP:

Years There:

Home Phone:

Work Phone:

Social Security Number:

- -

Birth Date:

/ /

Email Address:

PLEASE TELL US ABOUT YOUR JOB (PRIMARY BORROWER)

Current Employer:

Years There:

Phone Number:

Position:

Gross Montly Income:

Note: 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:

Source:

PLEASE TELL US ABOUT YOURSELF (CO-BORROWER)

Full Name:

Street Address:

Street Address 2:

City:

State:

ZIP:

Years There:

Home Phone:

Work Phone:

Social Security Number:

- -

Birth Date:

/ /

Email Address:

PLEASE TELL US ABOUT YOUR JOB (CO-BORROWER)

Current Employer:

Years There:

Phone Number:

Position:

Gross Montly Income:

Note: 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:

Source:

PLEASE SELECT FORM OF COLLATERAL:

Monthly Payments

Mortgage

Debt Payments:

Payment To:

Monthly Payment:

Balanced Owed:

Rent

Debt Payments:

Payment To:

Monthly Payment:

Balanced Owed:

Child Support

Debt Payments:

Payment To:

Monthly Payment:

Balance Owed:

Alimony

Debt Payments:

Payment To:

Monthly Payment:

Balance Owed:

Amount you pay in alimony or child support:

Are you a Co-Borrower on any other loans?

Yes

If yes, for whom:

Where:

Monthly Payment:

AGREEMENT

DISCLAIMER: I/WE HEREBY CERTIFY THAT ALL STATEMENTS MADE ARE TRUE AND COMPLETE, ARE SUBMITTED FOR THE PURPOSE OF OBTAINING CREDIT, AND THAT THE CREDIT UNION MAY RELY ON THEM FOR SUCH DETERMINATION. WE UNDERSTAND THAT FEDERAL LAW REQUIRES THE VERIFICATION OF IDENTIFICATION FOR ALL NEW ACCOUNTS SHOULD I NOT HAVE AN EXISTING ACCOUNT. I/WE AUTHORIZE YOU TO OBTAIN SUCH INFORMATION AS YOU MAY REQUIRE CONCERNING THE STATEMENTS MADE IN THIS APPLICATION AND PROPER IDENTIFICATION, AND AGREE THAT THE APPLICATION SHALL REMAIN YOUR PROPERTY, AND YOU ARE AUTHORIZED TO ANSWER QUESTIONS ABOUT YOUR CREDIT EXPERIENCE WITH ME/US.

I accept the terms of the disclaimer above and submit my application.

Security Code:

Loan Application

Loan Application

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