Loan Application

Open-End/Closed-End Personal Loans, Auto Loans, Boats/Motorcycle Loans Mortgage Loans, and Home Equity Lines of Credit (HELOCs). For your convenience, all loans can be paid through Payroll Deduction.

Type Requested

Loan Amount Requested

Loan Term Requested (Months)

Purpose of Loan

Repayment Method

Individual or Joint Credit?

Marital Status

Name

First Name

Last Name

Date of Birth

YYYY

Number of Dependents

Ages of Dependents

Separate with comma.

Home Phone Number

(###)

###

####

Work Phone Number

(###)

###

####

Cell Phone Number

(###)

###

####

Mother's Maiden Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Number of Years at Current Residence

Residence Type

Monthly Payment

Present Employer

Employer Phone Number

(###)

###

####

Employment Status

Job Title

Start Date

YYYY

Gross Salary (Yearly)

Other Income (Yearly

Other Income Source

Monthly Debts

Co-Applicant Information

Applies if there is a co-applicant only.

Co-Applicant Name

First Name

Last Name

Co-Applicant Date of Birth

YYYY

Co-Applicant Number of Dependents

Co-Applicant Age(s) of Dependents

Separate with comma.

Co-Applicant Home Phone Number

(###)

###

####

Co-Applicant Work Phone Number

(###)

###

####

Co-Applicant Cell Phone Number

(###)

###

####

Co-Applicant Email

Co-Applicant Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Co-Applicant Years at Current Residence

Co-Applicant Residence Type

Co-Applicant Monthly Payment

Co-Applicant Current Employer

Start Date of Employment

YYYY

Co-Applicant Employer Phone Number

(###)

###

####

Co-Applicant Employment Status

Co-Applicant Job Title

Co-Applicant Gross Salary (Yearly)

Co-Applicant Other Income

Co-Applicant Other Income Source

References

Reference Name (Nearest relative not living with you)

First Name

Last Name

Relationship to You

Reference Phone Number

(###)

###

####

Reference Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Preference

By typing your name in the field below, you certify that the above information is correct.

Online loan applications are only available to Social Security Credit Union members. Members must complete all required fields indicated * submit application and fax proof of income, to 205-323-0117.

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