Loan Application

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Account Number/ID:

* indicates a required field

Today's Date

1 LOAN INFORMATION:

1.1 Account Number- Applicant

1.2 Desired Loan Amount $'s*

1.4 Purpose of Loan

2 PRIMARY APPLICANT

2.1 Name

First *

Middle

Last *

2.2 Social Security Number *

2.3 Date of Birth mm/dd/yyyy *

2.4 E-Mail Address *

2.5 Phone Number *

2.6 Your Home Address

Street *

City *

State *

Zip Code *

2.7 Rent|Own|Parsonage *

2.7A Monthly Payment Amount *

2.8 Time at Residence- years/months

2.9 Previous Address (if less than 3 years at current residence)

Street

City

State

Zip Code

Years There

2.10 Current Employer *

2.11 Title or Position

2.12 Are you self employed?

Yes

No

2.13 Business Phone (& Extension)

2.14 How Long mm/dd/yyyy

(You do not need to provide information about alimony, child support, separate maintenance or other sources of income if you do not wish to have them considered as income.)

2.15 Income- Monthly *

2.16A Source of Other Income

2.17 Previous Employer (If less than 3 years at current employer)

2.18 Position at Previous Employer

2.19 Years at Previous Employment

2.20 OTHER INFORMATION

2.20H Are you required to pay alimony, child support or other support payments?

No

Yes

2.20H-1 If 2.20H is yes, what is the amount?

If you are applying for an Individual Loan, click below to submit your completed application.

3. JOINT APPLICANT

3.1 Joint Applicant Type

3.2 Name

First

Middle

Last

3.3 Social Security Number

3.4 Date of Birth mm/dd/yyyy

3.5a E-mail Address Same as Applicant?

Yes

No

3.5 If not the same, what is your E-mail Address?

3.6 Home Phone Number

3.7 Your Home Address

Street

City

State

Zip Code

3.8 Rent|Own|Parsonage

3.8A Monthly Payment Amount

3.9 Time at Residence

3.10 Previous Address (if less than 3 years at current residence)

Street

City

State

Zip Code

Years There

3.11 Current Employer

3.12 Title or Position

3.14 Business Phone (and extension)

3.15 Start Date

(You do not need to provide information about alimony, child support, separate maintenance or other sources of income if you do not wish to have them considered as income.)

3.16 Monthly Income

3.17 Source of Other Monthly Income

3.18 Previous Employer

3.19 Position at Previous Employer

3.20 Years at Previous Emploment

3.21 OTHER INFORMATION

3.21H Are you required to pay alimony, child support or other support payments?

No

Yes

3.21I If yes to 3.21H, what is the amount?

4 OTHER INFORMATION

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By submitting this application, you warrant the truth of the above information and You realize that it will be relied upon by the Credit Union in deciding whether or not to grant the credit applied for. You hereby authorize the Credit Union, its employees and agents to investigate and verify any information provided to the Credit Union by you. You agree and understand that if approved, you are contractually liable according to the applicable terms of the Loan Agreement and Consumer Credit Disclosure Statement (Agreement). You will receive a copy of the Agreement no later than the time of your first credit advance and you promise to pay all amounts charged to your account according to its terms. If this is a joint application, you agree that such liability is joint and several. You authorize us to accept your facsimile signatures or electronic signatures on this application and agree that your facsimile signature and/or electronic signature will have the same legal force and effect as your original signature. You assume any risk that may be associated with permitting us to accept your facsimile and/or electronic signature. The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

North Canton Office

8800 Cleveland Ave. NW
P.O. Box 2800
North Canton, OH 44720
800-831-3972

Cincinnati Office

431 Ohio Pike, Suite 100 North
Cincinnati, OH 45255
800-373-1059
513-528-1521

Indianapolis Office

301 Pennsylvania Pkwy
Suite 300
Indianapolis, IN 46280
317-677-2191

More information about our locations.

By members choice, all accounts are insured to $250,000 by ASI (American Share Insurance) a private member owned insurer. This institution is not federally insured. Members accounts are not insured or guaranteed by any government agency or government sponsored agency. MEMBER ACCOUNTS ARE NOT INSURED OR GUARANTEED BY ANY GOVERNMENT OR GOVERNMENT SPONSORED AGENCY

Founding Member of the Christian Credit Union Network. Established 2002.

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Loan Application