United savings home page

Secure Loan Application


PO Box 2308, Fargo, ND 58108
Phone: (701) 235–2832  •  Fax: (701) 235–8376
   
Type Of Loan Applying For











Purpose / Collateral:
Requested Amount : $ .00


Payment Protection Coverage
Single Credit Life Insurance                              Joint Credit Life Insurance                              None
Single Credit Disability                                      Joint Credit Disability                                       None


Applicant Information
Applicant's Name:
Account #:
Driver License #:
Social Security #:
Email Address:
Birthdate (MM/DD/YY):
Number of Dependants :
Age of Dependants :
Home Phone #:
Mobile Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Is Joint Applicant your spouse? Yes No
Account #:
Driver License #:
Social Security #:
Email Address:
Birthdate (MM/DD/YY):
Number of Dependants :
Age of Dependants :
Home Phone #:
Cell Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:


Employment Information
Applicant Employer's Name:
Employer Phone #:
Employer Address:
Position:
Status: Full Time Part Time
Date Hired (MM/DD/YY):
Gross Hourly Wage / Month Salary ($):
Other Income ($): per Month
Other Income Source :
If less than 5 years
Prev. Employers Name:
Prev. Job Start Date:
Prev. Job End Date:
Joint App. Employer's Name:
Employer Phone #:
Employer Address:
Position:
Status: Full Time Part Time
Date Hired (MM/DD/YY):
Gross Hourly Wage / Month Salary ($):
Other Income ($): per Month
Other Income Source :
If less than 5 years
Prev. Employers Name:
Prev. Job Start Date:
Prev. Job End Date:
NOTE: Alimony, child support, or separate maintenance income need not be revealed if You do not choose to have it considered as a basis for this credit request.


Debts & Assets
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
Child Support Payments / Alimony $
Assets:
Description: Value:
    
Description: Value:
    
Have you ever filed for bankruptcy or had debt adjustment under Chapter 13?
   Are you a party in a lawsuit?
   Have you ever had property foreclosed or repossesion in the last 7 years?
   Is your income likely to decline in the next two years?
Are you co-maker/endorser on any loan not listed above?
   If yes then for whom?
   If yes then to whom?
Are you a U.S. citizen or permanent resident alien?


References (Nearest relative not living with you)
First Name: Middle Name: Last Name: Suffix:
   Home Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?


 
Co-Applicant References
First Name: Middle Name: Last Name: Suffix:
   Home Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?


Contact Method
  How would you prefer to be contacted? Home Phone Cell Phone Email
 
  Additional Comments:


Submit Application

I/We understand that credit union membership is required to fully process this loan application and further documentation / signatures may be required. By submitting this form with your electronic signature(s), you agree that everything stated in this application is correct to the best of your knowledge and grant permission to United Savings Credit Union to perform the following. United Savings CU is authorized to validate your information, investigate your creditworthiness, employment history, and obtain a credit report. You understand that any false or misleading statement in your application may cause any loan or extension of credit to be in default. You authorize us to accept your facsimile signatures on this application and agree that your facsimile 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 signature. United Savings CU may keep this application whether or not it is approved.

By pressing the "Submit Application" button below, you agree to the above statement.  

Date:
 Primary Signature:
 Joint Signature: