Loan Application

Please complete this form on screen, print it out, sign where indicated and
mail, fax or bring it to the credit union.

***Membership Eligibility is Requirred***
If sending by fax, please send to (901) 545-3785.

Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself and the Co-Applicant section about your spouse if:

Your spouse will use the account, or
You are relying on your spouse's income as a basis for repayment.
If you are relying on income from alimony, child support or separate maintenance, complete the Co-Applicant section to the extent possible about the person on whose payments you are relying.
If you are applying for Joint Credit with another person, complete the Applicant and Co-Applicant sections.

Type and Amount of Credit You're Requesting*

Loan Rates More about Loans Visa Credit Disclosure

Is this your first loan from us?	Yes No
Amount/Credit Limit Requested:	$
Approximate Time to Repay:	How Many? Periods:
Loan Type:
Security Offered:	(for secured credit only)
Type of Credit:	Individual Joint

*To Help Expedite Your Loan Process...

     To speed up the processing of your loan request please send the following
     information along with your loan application:

            A copy of your latest pay stub(s).
            If a new vehicle: a copy of a Buyer's Agreement from the dealer.
              If a used vehicle purchased from a dealer: same as new vehicle.
              If a used vehicle purchased from an individual or refinancing from another financial
                institution: a copy of vehicle registration or make of vehicle, model, VIN, current mileage.

Tell Us About Yourself

Applicant	Co-Applicant
Name:	Name:
Social Security #:	Social Security #:
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state: Married Separated Unmarried (Single - Divorced - Widowed)	Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state: Married Separated Unmarried (Single - Divorced - Widowed)

Driver's License #: State:	Driver's License #: State:
Birth Date:	Birth Date:
Home Phone: Business Phone: Cell Phone:	Home Phone: Business Phone: Cell Phone:
Present Address: No P.O. Box Years There: Own Rent	Present Address: No P.O. Box Years There: Own Rent

Applicant Debts	Co-Applicant Debts
Mortgage/Rent owed to:	Mortgage/Rent owed to:
Balance (Mortgage only):	Balance (Mortgage only):
Monthly Payment: Current APR % (Mortgage only):	Monthly Payment: Current APR % (Mortgage only):
Person Responsible for Payment:	Person Responsible for Payment:
Applicant Income	Co-Applicant Income
Employer:	Employer:
Employer's Address:	Employer's Address:
Employer's Phone:	Employer's Phone:
Date of Hire:	Date of Hire:
Employee's Position:	Employee's Position:
Income: $ Net Gross Annual Monthly Bi-weekly Weekly	Income: $ Net Gross Annual Monthly Bi-weekly Weekly
If employed less than 5 years list previous employer:	If employed less than 5 years list previous employer:
Employer:	Employer:
Employer's Address:	Employer's Address:
Employer's Phone:	Employer's Phone:
Date of Hire:	Date of Hire:
Employee's Position:	Employee's Position:
Income: $ Net Gross Annual Monthly Bi-weekly Weekly	Income: $ Net Gross Annual Monthly Bi-weekly Weekly
Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.) Source: $ Annual Monthly Hourly	Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.) Source: $ Annual Monthly Hourly
Applicant - Other Information	Co-Applicant - Other Information
Do you currently have any outstanding judgements or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under chapter 13, had property forclosed upon or repossessed in the last 7 years, or been a party in a lawsuit? YES NO	Do you currently have any outstanding judgements or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under chapter 13, had property forclosed upon or repossessed in the last 7 years, or been a party in a lawsuit? YES NO
If your answer is yes for any of the above, explain on a seperate sheet.	If your answer is yes for any of the above, explain on a seperate sheet.
Applicant References	Co-Applicant References
Debts paid off:	Debts Paid Off:
Creditor Name:	Creditor Name:
Address:	Address:

Telephone:	Telephone:
Creditor Name:	Creditor Name:
Address:	Address:

Telephone:	Telephone:
Nearest Relative:	Nearest Relative:
Relative Name:	Relative Name:
Address:	Address:
Telephone:	Telephone:
Relationship:	Relationship:
Personal Friend:	Personal Friend:
Friend's Name:	Friend's Name:
Address:	Address:
Telephone:	Telephone:

Signatures:

You promise that everything you have stated in this request is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You also agree to notify us of any change in your name, address or employment within a reasonable time thereafter. You authorize the credit union to obtain credit reports in connection with this request. 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. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on requests made to Federal Credit Unions or State Chartered Credit Unions insured by the NCUA. You understand that the credit union will rely on the information in the request and your credit report to make its decision.

X_________________________________________________
Applicant Signature and Date

X_________________________________________________
Co-Applicant Signature and Date

By submitting this loan request, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment.

You authorize the credit union to obtain credit reports in connection with this request.

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