White Earth Reservation Federal Credit Union Secure Loan Application

Loan Type

* Loan Type

* Purpose of Loan

* Requested Amount ($)

I have read and agree with the Credit Card Terms and Conditions

* Denotes required field.

Primary Applicant Information

*First Name

*Last Name

Account #

*Social Security #

*Date of Birth

*Email Address

Number of Dependents

Marital Status

*Primary Phone

Secondary Phone

*Street Address

*City

*State

*Zip Code

Current Address since

Rent, Own or Other

Payment ($)

Enter Previous Address

Number of Months

Primary Applicant Employment Information

Applicant Employer's Name

Employer Phone #

Employer Address

Status

Position

Date Hired

Monthly Salary($)

Other Income/Month($)

Other Income Source

Previous Job Start Date

Previous Job End Date

Previous Employer's Name

Outstanding Debts

Mortgage/Rent

Date of Loan

Orig. Debt

Pres. Balance

Payment

Past Due?

Auto Loan

Date of Loan

Orig. Debt

Pres. Balance

Payment

Past Due?

Credit Card (Combined)

Date of Loan

Orig. Debt

Pres. Balance

Payment

Past Due?

Other

Date of Loan

Orig. Debt

Pres. Balance

Payment

Past Due?

Other

Date of Loan

Orig. Debt

Pres. Balance

Payment

Past Due?

Are there any other persons obligated on any of the above loans?

Which ones & who?

Are you a co-maker, co-signer or guarantor on any loan?

For whom?

To whom?

Have you declared bankrupt in the last 14 years?

Joint Applicant Information

Is there a joint applicant for this loan?

Yes

No

*First Name

*Last Name

Account #

*Social Security #

*Date of Birth

*Email Address

Number of Dependents

Marital Status

*Primary Phone

Secondary Phone

*Street Address

*City

*State

*Zip Code

Current Address since

Rent, Own or Other

Payment($)

Enter Previous Address

Number of months

Joint Applicant Employment Information

Applicant Employer's Name

Employer Phone #

Employer Address

Status

Position

Date Hired

Monthly Salary($)

Other Income/Month($)

Other Income Source

Previous Employer

Previous Job Start Date

Previous Job End Date

Outstanding Debts

Mortgage/Rent

Date of Loan

Orig. Debt

Pres. Balance

Payment

Past Due?

Auto Loan

Date of Loan

Orig. Debt

Pres. Balance

Payment

Past Due?

Credit Card (Combined)

Date of Loan

Orig. Debt

Pres. Balance

Payment

Past Due?

Other

Date of Loan

Orig. Debt

Pres. Balance

Payment

Past Due?

Other

Date of Loan

Orig. Debt

Pres. Balance

Payment

Past Due?

Are there any other persons obligated on any of the above loans?

Which ones & who?

Are you a co-maker, co-signer or guarantor on any loan?

For whom?

To whom?

Have you declared bankrupt in the last 14 years?

Applicant References

Nearest relative not living with you

First Name

Last Name

Suffix

Primary Phone

Home Address

City

State:

Zip Code

Relationship

Enter Additional Comments

Submit Application

Everything that I have stated in this application is correct to the best of my knowledge. You are authorized to check my credit & employment history & to answer questions about your credit experience with me.

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