New Loan Request

Type of Loan Requsted

Amount Requested *

Purpose of Loan

Payment Protection

If you answer "yes", then the credit union will disclose the cost of this voluntary payment protection to you. A separate election which discloses the terms and conditions must be signed for protection to be effective. *

Yes

No

Applicant Information

About You

Member Number *

Enter Social Security Number *

Driver License Number

Date of Birth *

Street Address *

Street Address Link 2

City *

Enter ZIP Code *

Email *

Enter Phone *

Length of Residence *

Rent or Own

Do You Rent or Own *

Rent

Own

Live with other

Housing Information

Mortgage or Rent Payment *

Who do you make your payment to? *

Joint Applicant (if desired)

First and Last Name

Date of Birth

Enter Social Security Number

Email

Enter Phone

Applicant Employment and Income

Name of Employer *

Enter Gross Income *

Start Date *

Pay Frequency

Other Income

Other Income Frequency

Source of Other Income

Joint Applicant Employment and Income

Name of Employer

Enter Gross Income

Start Date

Pay Frequency

Other Income

Other Income Frequency

Source of Other Income

STATE LAW NOTICES

OHIO RESIDENTS ONLY: the Ohio laws against discrimination require that all make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

I agree to the terms and conditions above.

WISCONSIN RESIDENTS ONLY: (1) No provision of any marital property agreement, unilateral statement under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

I agree to the terms and conditions above.

STATE LAW NOTICES

1. You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes you will notify use in writing immediately You authorize the Credit Union to Obtain credit reports in connection with its application for credit and for any update, increase, renewal, extension or collection of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report 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. 2. If you are applying for a credit card, you understand that the use of your card will constitute acknowledgment of receipt and agreement to the terms of the credit card agreement and disclosures. You grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure your credit card account. When you are in default, you authorize us to to apply the balance in these accounts to any amounts due. Shares and deposits in an individual Retirement Account, and any other account that would lose special tax treatment under state or federal law if given as security, are not subject to the security interest you have given in your share and deposits.

I agree to the terms and conditions above

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Thank you for your loan request. A Combined Employees Credit Union Loan Officer will reach out soon for any additional information required and to complete your loan. If you have any questions, please call us at 478-929-5700 (option 2) or email creditunion@combinedecu.com. Have a great day!