Are you currently a member of the credit union?

Yes

No

Type of Loan:    

If vehicle, list year, make, model and mileage

First Name:       

Last Name:       

Email:                

Current Employer

By completing the following loan application, you are authorizing the credit union to obtain a credit report and check your employment history.

1) Is this an individual or joint application?

Individual

Joint

2) Please estimate the co-applicant annual income before taxes, in whole dollars (if applicable):

3) Please estimate your annual income before taxes, in whole dollars:

4) Additional income and source:

5) Is the address the credit union has correct?

Yes

No

6) Please enter the phone number, including area code, you would like us to contact you at regarding this loan application:

7) Please choose the time of day it is best to contact you regarding this loan application:

anytime

before 8 AM

between 8 AM and 5 PM

8) Enter the number of years employed with your current employer. Enter zero if not currently employed. Enter 1 if employed less than one year:

9) Please enter your monthly mortgage or rent payment, in whole dollars:

10) Please enter the total amount of monthly loan payments on other outstanding loans, in whole dollars:

11) Enter the amount you wish to borrow in whole dollars:

12) Enter the desired monthly payment amount:

13) Do you wish to open a Visa Credit Card?      Yes

14) Do you wish to open an EZ Access Line of Credit?      Yes

15) Are you interested in Route 66 Mechanical Protection Coverage for your new or used vehicle? Card?      Yes