Southern Butler County Community Credit Union Loan Application Form

Please fax or mail a copy of your latest pay stub to us for income verification purposes after completing this application.

Applicant Information:
Name:
Account Number:
E-mail address:
Social Security #:
Driver's License Number:
Birth Date:
Home Phone:
Cell Phone:
Mother's Maiden Name:
Present Address:  
Street:
City:
State:
Zip:
How many years have you lived at your current address?
Do you rent or own? Rent Own
Current Employer:
Employer's Phone:
Date Started:
Job Position/Title:
Est. Monthly Salary: $
Other Monthly Income: $
Source of Other Income:
Ever had a Repossession? No Yes
Ever had a Judgment entered against you? No Yes
Ever declared Bankruptcy? No Yes
   
Co-Applicant Information:
Name:
Cu Account #(If any):
Social Security #:
Birth Date:
Current Employer:
Employer's Phone:
Date Started:
Job Position/Title:
Est. Monthly Salary: $
   
Loan Information:
Type of Loan:
How many years to pay this back?
Amount Requested: $
Would you like credit disability insurance on your loan? No Yes
Would you like full coverage net life insurance on your loan? No Yes
Loan Purpose:
If a vehicle loan, please describe the year, make,
model, VIN number, the dealership you are
purchasing from, and the name and phone number of your insurance company and agent.
   
Debts:
Debtor Current Balance Monthly Payment Consolidate Into New Loan?
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
If you have any other information you would like us to consider, or any comments or suggestions, please enter them  here:
You promise 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 what you owe. If there are any important changes you will notify us in wr iting immediately. 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. You understand that the Credit Union will rely on the information in this application and your credit reports 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 federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.
 

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