Application for Loan – Secured by Collateral Please enable JavaScript in your browser to complete this form.Applicant Name *Social Security Number *Birthdate:Month / Date / YearAddress: *Home Phone: *Work Phone: *Cell Phone: *Cell Phone: (copy) *Marital Status *UnmarriedMarriedSeparatedEmployer Name: *Employer Address: *How Long Employed: *Position: *Hourly Rate *File Upload (A Current Pay Stub will be REQUIRED for Application Approval) Upload Below or Email to Bkmtnfcu@gmail.com: Click or drag a file to this area to upload. Other Personal Income (Amount and Source) *Are You Relying On Income From Another Person to Repay This Loan (yes or no): *YesNoIf Yes, Name & Address:You do not need to disclose the following income unless you wan the Credit Union to consider such income in approving this loan:Alimony $___________/monthly; Child Support $___________/monthly; Spousal Support $__________/monthly LOAN REQUEST INFORMATIONI hereby apply for a loan of $ *Enter Total AmountFor a period of This Many Months *Enter Total Number of MonthsIn Monthly Installments Of? *Each Installment Including InterestI desire this loan for the following purpose: *Would you like to have a payroll deduction? *YesNoI HEREBY PLEDGE THE FOLLOWING REAL ESTATE IN WHICH I (WE) HAVE EQUITY TO OBTAIN THIS LOAN:Auto Make/Model *Year *Owners(s) *IF LOAN IS APPROVED, THE TITLE & INSURANCE INFORMATION MUST BE PROVIDED AT THE TIME OF THE LOAN. FULL INSURANCE COVERAGE MUST BE MAINTAINED FOR THE LENGTH OF THE LOAN.Other collateral offered (describe fully) *Owners(s) of collateral *Debt/income ratio (to be calculated by the Credit Union)Are YOU liable for alimony, child or spousal support, or other maintenance payments (yes or no)? *YesNoIf yes, what is the monthly amount paid?Please enter the monthly amount paidAre payments up to date (yes or no)?YesNoNumber of Dependents, Excluding Yourself? *Enter number of Dependents Excluding YourselfReal Property; Rent or Own? *(Please be sure to include the monthly rental or mortgage payments on the above list of indebtedness)Do you have any judgements, garnishments or legal proceedings against you (yes or no)? *YesNoIf yes, please explain:Have you ever been through bankruptcy (yes or no)? *YesNoIf yes, what year?Are you a co-maker or guarantor on any other loans (yes or no)? *YesNoIf yes, what is the balance of the loan amount and the monthly payment? Who is the loan for:Please include balance of loan, the monthly payment and who the loan is for.I hereby certify that all statements made on both sides of this Application are true, complete and submitted for the purpose of obtaining credit. The Credit Union is authorized to check my credit, employment history, and obtain whatever other information is necessary to process this loan.Signature and Date **Please type your name as your signature and include the date.DO YOU WANT LOAN DISABILITY INSURANCE (yes or no)? *YesNoDO YOU WANT LIFE INSURANCE (yes or no)? *YesNoDebt/Income Ration (to be calculated by the Credit UnionI/we hereby approve this loan in the amount and on the conditions set forth above:To be completed by Business Mgr: Share balance $________________ Loan balance $________________ Loan status___________________ Account #____________________ Loan/Note #__________________ ______________________________________________ ❏ Loan Officer Approval ____________________ Date ❏ Credit Committee Approval Submit