Loan Application

Type And Amount Of Credit You're Requesting
Is this your first loan from us? Type of Credit
Payment Protection Coverage (Check If Desired)
Check coverage(s) desired. We will disclose the cost of this Payment Protection Insurance - Credit Disability and Credit Life - to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.
Do you want your loan protected for you and your family if you become disabled?
Do you want your loan protected for you and your family in the event of your death?
Primary Applicant
Own or Rent?  
 
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Marital Status
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:

Debts

Mortgage Information
Home Equity/Second Mortgage
 
 
Income
 
 
Other Income
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.)
Current pay stub must be faxed to 203-622-7409

 

Joint Applicant
Own or Rent?  
 
(-
(-
(-
Marital Status
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:

Debts

Mortgage Information
Home Equity/Second Mortgage
 
 
Income
 
 
Other Income
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.)
Current pay stub must be faxed to 203-622-7409
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. By signing below, you agree to the terms of the Credit Card Agreement which will be sent with the card and you agree to pay all charges incurred in accordance with the terms of that Agreement.

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.