Loan Application - SIU Credit Union - Banking for a Better Way of Life


	Consumer Loan Application

Choose a Loan Type:

Loan Type:
Credit Limit Requested:
Collateral Offered:
	* Please list any items you wish to use as collateral for repaying this loan.

I am applying for:	Individual Credit	Individual Credit with Authorized User
	Joint Credit	Joint Credit with Authorized User

Leave this section blank if there is no Co-Applicant

First Name:
Middle Name:
Last Name:
Member Number:
Email Address:
Home Address:
City:
State:		Zip:
How Long?
Home Phone:
Work Phone:
Birthdate:
Social Security #
Drivers License #		State:
Nearest Relative (not living with you)
Address of Relative:
City:
State:		Zip:
Relative Phone #

Relationship to Applicant:
First Name:
Middle Name:
Last Name:
Member Number:
Email Address:
Home Address:
City:
State:		Zip:
How Long?
Home Phone:
Work Phone:
Birthdate:
Social Security #
Drivers License #		State:
Nearest Relative (not living with you)
Address of Relative:
City:
State:		Zip:
Relative Phone #

For Faster Processing, Include Recent Income Verification

INCOME SOURCE

CO-APPLICANT INCOME SOURCE

Employer/Income Source:
Position:
Starting Date:
Gross Annual Income:
Source of Other Income:
Per Month:

Employer/Income Source:
Position:
Starting Date:
Gross Annual Income:
Source of Other Income:
Per Month:

Income from Alimony, Child Support or Separate Maintenance Payments does not need to be revealed if you do not choose to have it considered as basis for repaying this obligation.

LOANS & OBLIGATIONS

Include spouse/co-applicant if that section on original application is completed.
Please check one: (A = Applicant; B = Spouse/Co-Applicant; or C = Both)

	Lender Name	Market Value	Present Balance	Monthly Payment	A	B	C
Landlord or Mortgage
Loan or Contract on Vehicle

CREDIT INSURANCE (OPTIONAL)

DISCLOSURE: You or Your means the member and the joint insured (if applicable.) Credit insurance is voluntary and not required in order to obtain this loan. You may select any insurer of your choice. You may get this insurance only if you check the yes box below. The rate you are charged for the insurance is subject to change. You will receive written notice before any increase goes into effect. You have the right to stop this insurance by notifying your credit union in writing. By submitting this electronic application you agree that: if you select insurance, you authorize the credit union to add the charges for insurance to your loan each month. You are eligible for disability insurance only if you are working for wages for 25 hours or more a week on the date of any advance. If you are not, that particular advance will not be insured until you return to work. If you are off work because of temporary layoff, strike or vacation, but soon to resume, you will be considered at work. This insurance product is not insured by Government or FDIC. This insurance product is not insured by SIU Credit Union. The extension of credit is not conditioned on purchase of optional credit insurance.

COVERAGE SELECTED:	Single Credit Life	Joint Credit Life	Credit Disability

Cost Disclosure: Credit Life Rate per $100 of the Cycle-End Balance is 0.064 for Single or 0.106 for Joint Credit/Disability Rate per $100 of the Cycle-End Balance is 0.382

Additional Information:
Please provide any additional information or comments about your application:

How did you learn about our online loan application?

If you choose "Other," please specify:

Application & Consent
By clicking the "Submit Application" button below and submitting this application electronically, you agree that the information you supplied is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment. You also authorize the credit union to obtain credit reports in connection with this request.

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