Wellness Loan Application

Select Loan Type *

Loan Amount Requested: *

Months

Loan Purpose

Describe Collateral

Name *

Social Security Number *

Date of Birth *

Email Address *

Home Phone Number *

Home Address *

Years at Residence *

Rent/Own *

Previous Address

Authorize Credit Report

Yes No

Joint Applicant

Yes No

Previous Joint Applicant *

Name *

Social Security Number *

Date of Birth *

Email Address *

Home Phone Number *

Home Address *

Years at Residence *

Rent/Own *

Previous Address

Authorize Credit Report

Yes No

Current Employer *

Title or Position *

Business Phone Number *

Start Date

Monthly Salary *

Other Monthly Income

Source of Other Income

How many years at this Job?

Current Employer *

Title or Position *

Business Phone Number *

Start Date

Monthly Salary *

Other Monthly Income

Source of Other Income

How many years at this Job?

Credit Union Accounts	Value

Enter Your Additional Assets

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Debt Information

Credit Bureau Debts	Balance	Monthly Payments	Paid Off

Credit Union Loans	Balance	Monthly Payments	Paid Off

Other Debts	Balance	Monthly Payments

+ Add Additional Debts

Join Member Section

Credit Bureau Debts	Balance	Monthly Payments	Paid Off

Other Debts	Balance	Monthly Payments

+ Add Additional Debts

Name *

Home Phone *

Home Address *

Relationship *

Name *

Home Phone *

Home Address *

Relationship *

Loan Information

Desired Loan Amount:

Loan Purpose:

Repayment Term:

Collateral:

Applicant

Name:

Address:

Social Security Number:

Date of Birth:

Home Phone:

Email Address:

Years at Residence:

Rent/Own:

Name:

Address:

Social Security Number:

Date of Birth:

Home Phone:

Email Address:

Years at Residence:

Rent/Own:

Employment

Employer:

Position:

Business Phone Number:

Start Date:

Monthly Salary:

Other Monthly Income:

Other Monthly Income Source:

Employer:

Position:

Business Phone Number:

Start Date:

Monthly Salary:

Other Monthly Income:

Other Monthly Income Source:

Debts

Review Member Section

Credit Bureau Debts	Balance	Monthly Payments	Paid Off

Credit Union Loans	Balance	Monthly Payments

Creditor	Balance	Monthly Payment

Review Joint Member

Credit Bureau Debts	Balance	Monthly Payments	Paid Off

Creditor	Balance	Monthly Payment

References

Full Name:

Home Phone:

Address:

Relationship

Full Name:

Home Phone:

Address:

Relationship

Additional Information

Is military duty station transfer expected during this next year?

Are there currently any outstanding judgments against you?

Any bankruptcy filing or debt adjustment confirmed under Ch. 13 against you?

Any foreclosures or lost title/deed on property in past 7 years?

Are you a party to any lawsuit?

Are you other than a US citizen/permanent resident alien?

Is your income likely to decline within the next 2 years?

Are you a co-maker/endorser on any note?

Are you a member at another credit union?

Joint Additional Information

Is military duty station transfer expected during this next year?

Are there currently any outstanding judgments against you?

Any bankruptcy filing or debt adjustment confirmed under Ch. 13 against you?

Any foreclosures or lost title/deed on property in past 7 years? *

Are you a party to any lawsuit?

Are you other than a US citizen/permanent resident alien? *

Is your income likely to decline within the next 2 years?

Are you a co-maker/endorser on any note?

Are you a member at another credit union?

Joint Additional Information

Joint Additional Information

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