LAKESIDE FEDERAL CREDIT UNION
                                              ELECTRONIC APPLICATION FOR CREDIT

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Before filling-in this form, go to File, do a "save as" under a different filename, i.e., your initials and today's 
date.  When you have completed it, save it again, print it locally, and attach it to an email. 
Send it to:  lsfcu@netnitco.net. 
This form is done in Microsoft Notepad. You can add spaces where necessary if you want to include
additional information. Use your mouse to move to each selection.
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Date:		Member Acct #:		Note #:
Type of Credit ("x"): [  ] Open-end, line-of-credit, special plan.  [  ] Closed-end Loan.  [  ]Co-Signer.
Co-signer for: 		Refinanced Amount: $
Amount Requested: $		Purpose of Loan:		
("x" ) [  ] Credit Life Insurance  [  ]Credit Disability Insurance
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Full Name:		Date of Birth:		SSN:
Street Address:
City:		State:		ZIP:		Phone:
Years at this Residence?:		No.of Dependents:		Drivers Lic #:
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Previous Street Address:
City:		State:		ZIP:		No.Years at this Address:

Employed by:				Position:
No.Years Employed:		Take-Home Pay:		
("x")  Pay is: [  ]Weekly  [  ]Bi-weekly  [  ]Monthly  [  ]Semi-monthly.
Employer's Phone Number:

Previous Employer:			No.Years Employed:	Monthly Income:$
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                                                   OTHER INCOME

Source:				Date Began:		Monthly Amount:$
Source:				Date Began:		Monthly Amount:$
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                                 ALIMONY, CHILD SUPPORT, OR MAINTENANCE INCOME
Note: You need not disclose the following sources of income; but if you want the credit union to consider
such income in connection with this loan application, please compete the following:

Alimony:$	Person Liable:		Child Support:$		Person Liable:
Maintenance:$		Person Liable:			Ages of Children:

Income received is pursuant to a ("x"): [  ]written agreement.  [  ]court decree.  
Are payments up-to-date? ("x")  [  ]Yes  [  ]No
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Nearest Relative (not living with you):			Relationship:
Tel#:		Street Address:
City:		State:		ZIP:
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Your Home ("x"): [  ]Own   [  ]Rent   [  ]Buying. Name in which titled:
Landlord/Mortgage holder:				Value:$		Balance:$
Monthly Payments:$

Insurance Agent's Name:
Street Address:			
City:		State:		ZIP:		Phone#:
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Make of Auto:		Year:		Financed by:
Titled to:			Value:$
Balance:$		Monthly Payments:$

Make of Auto:		Year:		Financed by:
Titled to:			Value:$
Balance:$		Monthly Payments:$

Auto Insurer Name:
Street Address:
City:		State:		ZIP:
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              STATEMENT OF INDEBTEDNESS AND LIABILITIES FOR WHICH YOU ARE
                                          OBLIGATED IN ANY MANNER

Creditor Name:			Account#:		Amount:$
Balance:$		Montly Payments:$
Creditor Name:			Account#:		Amount:$
Balance:$		Montly Payments:$
Creditor Name:			Account#:		Amount:$
Balance:$		Montly Payments:$
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Savings Account at:			Acct #:
Balance:$
Checking Account at:			Acct #
Balance:$
Stocks, Bonds:				No.Shares:		Value:$

Your Estimated Net Worth:$
________________________________________________________________________________________

This application is designed to be sent electronically. It was created in "Notepad" and can be saved as a
regular text (.txt) file, attached to an email and sent electronically to: lsfcu@netnitco.net, or printed locally
and faxed to 219-845-7260.
By sending this application you are swearing/affirming, under penalities of perjury, that all information con-
tained herein is true and accurate. You further authorize a check of your credit and employment history 
from time-to-time as we deem necessary and to answer questions from others about your credit experience
with us.


Your Name:		Date: