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Loan Application

ACCOUNT NUMBER: AMOUNT REQUESTED:  
 
TERM: METHOD:
PAYMENT AMOUNT:
1 Year
5 Years
8 Years
Other
Payroll
Automated Fund Transfer

FREQUENCY:
WEEKLY
SEMI-MONTHLY
BI-WEEKLY
MONTHLY 		PURPOSE:
LOAN TYPE:
VARIABLE RATE
HOME EQUITY LINE OF CREDIT
STUDENT LINE OF CREDIT
APPLICANT INFORMATION
GIVEN AND SURNAME :
SIN :
Birth Date :
TELEPHONE :
Driver's License :
MARITAL STATUS :
Single   Married

DEPENDANTS :
CO-APPLICANT INFORMATION
GIVEN AND SURNAME :
SIN :
Birth Date :
TELEPHONE :
Driver's License :
MARITAL STATUS :
Single   Married

DEPENDANTS :
SALARY INFORMATION
GROSS ANNUAL SALARY :
ADDITIONAL INCOME:
CO-APPLICANT SALARY :
TOTAL ANNUAL :
ADDRESS HISTORY
PRESENT ADDRESS: YRS THERE :
PREVIOUS ADDRESS : YRS THERE:
PREVIOUS ADDRESS : YRS THERE:
CO-APPLICANT ADDRESS HISTORY
PRESENT ADDRESS: YRS THERE :
PREVIOUS ADDRESS : YRS THERE:
PREVIOUS ADDRESS : YRS THERE:
REFERENCES
REF NAME :
ADDRESS :
RELATIONSHIP :
REF NAME :
ADDRESS :
RELATIONSHIP :
WORK HISTORY
NAME/ADDRESS CURRENT EMPLOYER : TELEPHONE :
YRS THERE : OCCUPATION : DEPARMENT :
PREVIOUS EMPLOYER ( IF LESS THAN THREE YEARS) : YEARS THERE :
CO-APPLICANT WORK HISTORY
NAME/ADDRESS CURRENT EMPLOYER : TELEPHONE :
YRS THERE : OCCUPATION : DEPARMENT :
PREVIOUS EMPLOYER ( IF LESS THAN THREE YEARS) : YEARS THERE :
ASSETS
ASSETS VALUE
LIABILITIES
TYPE CREDITOR BALANCE MONTHLY
OBLIGATIONS
TYPE CREDITOR BALANCE MONTHLY
TOTAL ASSETS : TOTAL LIABILITIES :
    NET WORTH :
REAL ESTATE
OWNED - LOCATION		 REGISTERED
OWNER		 YEAR PURCH. PURCHASE PRICE TAX AMOUNT

Have you ever made a proposal under the Bankruptcy and Insolvency Act in Canada or elsewhere?
Yes     No

Have you ever been bankrupt or declared bankruptcy in Canada or elsewhere?
Yes     No

The undersigned is not indebted to any other credit union, bank, loan agency, store or individual merchant , either as maker or endorser, except as stated above. The statements herein are made for the purpose of obtaining the loan, and are true to the best of my/our knowledge and belief.

I authorize the credit union to obtain such factual and investigative information regarding me from others as permitted by law and to furnish other credit grantors and any credit bureau particulars of this credit application. In addition, I hereby acknowledge notice from the credit union that a consumer report containing credit information may or will be referred to in connection with this application for credit or any renewal or extension thereof.

I hereby authorize the credit union to deduct the costs of security registration , processing or consumer reports from my account or loan proceeds.

If you agree with the terms outlined above, please click on the "YES" button following, slide the arrow from the "Locked" to "Unlocked" position and click on the "I agree to the above terms. Please process this loan application." bar to submit the application. Otherwise, please select the "NO" button and click CANCEL below to return to the Home Page.

Yes     No


Please use your mouse to slide the arrow from the "Locked" to "Unlocked" position in order to submit your application.
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