Buffalo Police FCU Loan Application

Will this be a Single or Joint Application? *

Single Application

Joint Application

First Name *

Last Name *

Email *

Phone (Best contact phone #) *

No dashes, spaces, or parentheses

Type of Loan *

Loan Term (in months) *

Amount Requested *

Repayment Method

Cash

Automatic Withdrawal

Payroll Deduction

Do you want Credit Disability Insurance in connection with this loan?

Yes, I want Credit Disability Insurance

No, I do not want Credit Disability Insurance

Do you want Credit Life Insurance in connection with this loan?

Yes, I want Credit Life Insurance

No, I do not want Credit Life Insurance

Primary Applicant - Personal information

Social Security No. *

No dashes, spaces, or parentheses

Driver's License No. *

No dashes, spaces, or parentheses

Driver's License State *

Date of Birth *

Address *

Address 2

City *

State *

Zip Code *

Years There *

No. of Dependents *

Complete for joint credit, secured credit, or if you live in a community property state *

I am Single

I am Married

I am Separated

Employment information

Current Employer *

Position *

Annual Income *

Employee Start Date *

Previous employer (if less than 2 years at present employer)

Start date

End date

Other Income

Source

Credit information

Residence

I own my residence

I rent my residence

I live with relatives

Present Mortgage Co., Landlord, or Relative

Monthly Mortgage/Rent Payment (includes taxes and insurance)

Current Value. If you own your home, what is the current value?

Mortgage Balance

Reference

Name of nearest relative not living with you *

Relatives Address *

City *

State *

Zip Code *

Relationship *

Phone *

No dashes, spaces, or parentheses

Joint Applicant - Personal information

First Name*

Last Name*

Email*

Phone (Best contact phone #)*

No dashes, spaces, or parentheses

Social Security No.*

No dashes, spaces, or parentheses

Driver's License No.*

No dashes, spaces, or parentheses

Driver's License State *

Date of Birth *

Address *

Address 2

City *

State *

Zip Code *

Years There *

No. of Dependents *

Complete for joint credit, secured credit, or if you live in a community property state *

I am Single

I am Married

I am Separated

Employment information

Current Employer *

Position *

Annual Income *

Employee Start Date *

Previous employer (if less than 2 years at present employer)

Start date

End date

Other Income

Source

Credit information

Residence

I own my residence

I rent my residence

I live with relatives

Present Mortgage Co., Landlord, or Relative

Monthly Mortgage/Rent Payment (includes taxes and insurance)

Current Value. If you own your home, what is the current value?

Mortgage Balance

Reference

Name of nearest relative not living with you *

Relatives Address *

City *

State *

Zip Code *

Relationship *

Phone *

No dashes, spaces, or parentheses

Disclosure and Agreement to Terms

I hereby certify that all information contained in the application is furnished for the purpose of obtaining the loan requested herein and is true to the best of my knowledge and belief. I further certify that no consideration has passed or will pass from me, as borrower, to an endorser for his endorsement or to co-maker for his/her signature. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. I have assisted the Credit Union in the preparation of this application; I have provided the Credit Union with all of the information contained therein; I hereby certify that this loan application is truthful and complete to the best of my knowledge and that I have read the entire completed application before signing same.

Do you agree with the above terms and conditions? *

Yes, I agree to the terms

No, I do not agree to the terms

Signature (type your full name) *

Date *

Co-Applicant

Do you agree with the above terms and conditions? *

Yes, I agree to the terms

No, I do not agree to the terms

Signature (type your full name) *

Date *