Credit Credit Application

* Indicates Required

• Important information about procedures for opening a new account

  To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your 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.

  General Information

  Will you be applying for Individual or Joint Credit? *

  Individual Joint

  Will you be applying for Individual or Joint Credit is required

  Marital Status

  Complete marital status if this loan is for:

  • a. Joint or secured credit, or
  • b. You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)

  Unmarried Married Separated This application is not for joint or secured credit and I do not live in the states listed above.

  Type of Card*

  Number of Cards*

  Limit Requested*

• Primary Applicant

  Member Number *

  First Name *

  Last Name *

  Middle Name

  Social Security Number (TIN) *

  Date of Birth *

  Driver's License Number *

  Driver's License State *

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Number of Dependents *

  Age of Dependents *

  Primary Phone Number *

  Work Phone

  Email Address *

  Mother's Maiden Name *

  Home Address

  Address *

  Address 2

  City *

  State *

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip *

  Years & Months at Current Residence *

  Monthly Payment *

  Residence Type *

  Own Rent Other

  Please Specify

  Residence Type is required

  Would you like to add a previous address?

  Yes No

  Previous Address

  Address

  Address 2

  City

  State

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip

  Years & Months at Current Residence

  Monthly Payment

  Residence Type

  Own Rent Other

  Please Specify

  Residence Type is required

  Present Employer

  Name *

  Phone Number *

  Start Date *

  Job Title *

  Gross Salary *

  Per *

  Year Month Hour

  Employment Status *

  Full Time Part Time Temp Retired Other

  Please Specify

  Employment Status is required

  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 *

  Per *

  Year Month Hour

  Other Income Source *

  Would you like to add a previous employer? *

  Yes No

  Previous Employer

  Name *

  Phone Number *

  Start Date *

  End Date *

  Job Title *

  Gross Salary *

  Per *

  Year Month Hour

  Employment Status *

  Full Time Part Time Temp Retired Other

  Please Specify

  Employment Status is required

  Joint Applicant

  Member Number *

  First Name *

  Last Name *

  Middle Name

  Social Security Number (TIN) *

  Date of Birth *

  Driver's License Number *

  Driver's License State *

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Number of Dependents *

  Age of Dependents *

  Primary Phone Number *

  Work Phone

  Email Address *

  Mother's Maiden Name *

  Home Address

  Address *

  Address 2

  City *

  State *

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip *

  Years & Months at Current Residence *

  Monthly Payment *

  Residence Type *

  Own Rent Other

  Please Specify

  Residence Type is required

  Would you like to add a previous address?

  Yes No

  Previous Address

  Address

  Address 2

  City

  State

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip

  Years & Months at Current Residence

  Monthly Payment

  Residence Type

  Own Rent Other

  Please Specify

  Residence Type is required

  Present Employer

  Name *

  Phone Number *

  Start Date *

  Job Title *

  Gross Salary *

  Per *

  Year Month Hour

  Employment Status *

  Full Time Part Time Temp Retired Other

  Please Specify

  Employment Status is required

  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 *

  Per *

  Year Month Hour

  Other Income Source *

  Would you like to add a previous employer? *

  Yes No

  Previous Employer

  Name *

  Phone Number *

  Start Date *

  End Date *

  Job Title *

  Gross Salary *

  Per *

  Year Month Hour

  Employment Status *

  Full Time Part Time Temp Retired Other

  Please Specify

  Employment Status is required

• References

  Nearest relative not living with you

  First Name *

  Last Name *

  Relationship *

  Phone Number *

  Address *

  Address 2

  City *

  State *

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip *

• Debts & Monthly Payments

  List all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support, child care, medical, utilities, auto insurance, IRS liabilities, etc.). Please use a separate line for each credit card and auto loan.

  Debts	Monthly Payment
  Debt Name #1	Debt Monthly Payment #1
  Debt Name #2	Debt Monthly Payment #2
  Debt Name #3	Debt Monthly Payment #3
  Debt Name #4	Debt Monthly Payment #4
  Debt Name #5	Debt Monthly Payment #5
  Debt Name #6	Debt Monthly Payment #6
  Debt Name #7	Debt Monthly Payment #7
  Debt Name #8	Debt Monthly Payment #8
  Debt Name #9	Debt Monthly Payment #9
  Debt Name #10	Debt Monthly Payment #10

• Additional Information

  How would you prefer to be contacted?

  Primary Phone Work Phone Email Address Other

  Please Specify

  Email List

  Please add me to your email list.

  Special Instructions/Comments

  Agreements & Disclosures

  Income verification is required; other information may be required.

  I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Financial Institution, information concerning me or my affairs.(Sec. 1014, Title 18, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.)