Lakeside Federal Credit Union - On-Line Application for Credit
Please Note: This Credit Union complies with the Equal Credit Opportunity Act. Married members may apply for credit individually. This form may be used if you are applying to be a co-signer. Please answer all questions as completely as possible. This form will be sent by email and is not secure. You are welcome to visit our office and submit an application for credit in person.

DATE: MONTH DAY YEAR:20  MEMBER ACCOUNT # NOTE #   CHECK: OPEN-END CREDIT,LINE-OF-CREDIT, OR SPECIAL LOAN   CLOSED-END LOAN   CO-SIGNER
CO-SIGNER FOR:  REFINANCED AMOUNT: $   AMOUNT REQUESTED: $
  CREDIT LIFE INSURANCE   CREDIT DISABILITY INSURANCE   PAYABLE IN INSTALLMENTS OF EACH    INCLUDING INTEREST    PLUS INTEREST
  BI-WEEKLY   WEEKLY   SEMI-MONTHLY   MONTHLY   DUE ON THE OF EACH  PURPOSE OF LOAN:
CO-SIGNER OR SECURITY OFFERED:

NAME (FIRST,MIDDLE,LAST):  DATE OF BIRTH (MO/DA/YEAR):  SOCIAL SECURITY # - -   PHONE # -
RESIDENCE ADDRESS: CITY: STATE:  ZIP:  RESIDED HERE FOR YEARS.         CO-APPLICANT'S NAME:
LIST PREVIOUS ADDRESSES IN THE LAST THREE YEARS:

EMPLOYED BY:  HOW LONG?  POSITION:  TAKE-HOME PAY: $   WEEKLY   BI-WEEKLY   SEMI-MONTHLY   MONTHLY
CHECK HERE IS YOU ARE SELF-EMPLOYED: TYPE OF BUSINESS: If you are self-employed you may be required to submit financial statements and tax returns.

OTHER INCOME (DO NOT INCLUDE ALIMONY, CHILD SUPPORT, MAINTENANCE PAYMENTS OR CO-APPLICANT'S INCOME).
SOURCE: DATE BEGAN:  MONTHLY $
SOURCE: DATE BEGAN:  MONTHLY $

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 application, please complete the following:

ALIMONY $ NAME OF PERSON LIABLE:   CHILD SUPPORT $ NAME OF PERSON LIABLE:
MAINTENANCE PAYMENTS $ NAME OF PERSON LIABLE:       INCOME RECEIVED A RESULT OF (CHECK ONE): AGREEMENT    COURT DECREE
AGES OF CHILDREN (IN YEARS):   HOW LONG HAVE ABOVE PAYMENTS BEEN MADE (YEARS)?  ALL PAYMENTS ARE UP-TO-DATE? YES    NO

NEAREST RELATIVE NOT LIVING WITH YOU: RELATION: COMPLETE ADDRESS:
PHONE # -

YOUR HOME: BUYING    OWN   RENT   NAME OF MORTGAGE HOLDER/LANDLORD:   NAME IN WHICH TITLED:   VALUE $
MORTGAGE PAYMENTS:  CURRENT BALANCE $   MONTHLY PAYMENT $   INSURANCE AGENT'S NAME:   AGENT'S PHONE# -
INSURANCE AGENT'S FULL ADDRESS:

AUTOMOBILES:

MAKE: YEAR: FINANCED BY: TITLED TO: VALUE $ BALANCE $ MONTHLY PAYMENT $
MAKE: YEAR: FINANCED BY: TITLED TO: VALUE $ BALANCE $ MONTHLY PAYMENT $
INSURANCE AGENT'S NAME, ADDRESS, & PHONE (WITH AREA CODE):

WHAT DO YOU CURRENTLY OWE? STATEMENT OF TOTAL INDEBTEDNESS:

NAMES IN WHICH
ACCOUNT APPEARS
NAME OF CREDITOR
ACCOUNT #
ADDRESS
ORIGINAL AMT $
SECURITY
BALANCE
MO.
PAYMNTS

IF YOU HAVE ANY OTHER DEBTS OUTSTANDING PLEASE LIST THEM BELOW:

CHECKING ACCOUNTS, SAVINGS ACCOUNTS, STOCKS & BONDS:

BANK/STOCK:   ACCT#   BALANCE $   TYPE OF ACCOUNT/STOCK (CHECKING, SAVINGS, BONDS):
BANK/STOCK:   ACCT#   BALANCE $   TYPE OF ACCOUNT/STOCK (CHECKING, SAVINGS, BONDS):
BANK/STOCK:   ACCT#   BALANCE $   TYPE OF ACCOUNT/STOCK (CHECKING, SAVINGS, BONDS):

ARE YOU A CO-SIGNER ON ANY OTHER LOANS? YES    NO
ANY LEGAL PROCEEDINGS CURRENTLY AGAINST YOU?   YES   NO
DO YOU PAY ALIMONY, CHILD SUPPORT OR MAINTENANCE PAYMENTS?    YES   NO   IF YES, HOW MUCH? $ /MONTH
HAVE YOU EVER FILED BANKRUPTCY?  YES    NO    IF YES, WHEN?   REASON:

 

I/WE SWEAR OR AFFIRM, UNDER PENALTIES OF PERJURY, THAT ALL INFORMATION ON THIS APPLICATION IS TRUE AND ACCURATE. I/WE FURTHER SWEAR OR AFFIRM THAT THE STATEMENT OF DEBTS CONTAINED IN THIS APPLICATION IS TRUE, ACCURATE, AND IS A COMPLETE LISTING OF ALL MY/OUR DEBTS AND OBLIGATIONS. THIS APPLICATION IS PRESENTED TO INDUCE THE CREDIT UNION TO EXTEND CREDIT TO ME/US ON MY/OUR BEHALF.

I/WE AUTHORIZE YOU TO CHECK MY/OUR CREDIT AND EMPLOYMENT HISTORY FROM TIME TO TIME AS THE CREDIT UNION DEEMS NECESSARY AND TO ANSWER QUESTIONS FROM OTHERS ABOUT YOUR CREDIT EXPERIENCE WITH ME/US.

PLACING A CHECK MARK HERE WILL CREATE YOUR ELECTRONIC SIGNATURE====>>>    SIGNATURE                

YOUR EMAIL ADDRESS IS REQUIRED TO COMPLETE THIS APPLICATION:   (Example: johndoe@myservice.net)

 

                      

 

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