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Loan Application

Please fill out and submit the following information. A loan officer will contact you once your application has been processed.

Please choose one

Your contact information


Date of Birth


Home Phone

Employer Information

Employer’s Address

Employer’s Phone

Loan Information

Co-Applicant Information
If you answered “YES” to the question above, please fill out this information. If you answered “No” you may proceed to the next section.

Co-Applicant Name

Co-Applicant Date of Birth

Co-Applicant Address

Fill out if different from your address listed above
Co-Applicant’s Phone

Co-Applicant’s Employer’s Phone

Enter “0” of none.




Please add up any other debt and specific in the field below.


Auto/Motocycle/RV/Trailer Information
Fill out this section if your loan/refinance is for a vehicle or trailer.

Personal/Other Loan information

In addition to rent or mortgage, list all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support, child care, medical utilities, auto insurance, IRS Liabilities, etc.) Please use a separate line for each credit card or auto loan. Please Note: Income verification and other information may be required. Alimony, child support, or separate maintenance income need not be listed unless you choose to have such income considered regarding extension and repayment of the credit requested. I certify that statements on this page are true and complete. I authorize any person, association, firm, or corporation to furnish, on request of this Credit Union, information concerning me or my affairs. (Sec. 1014, Title 13, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application of a Federal Credit Union.) Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers. The Ohio Civil Rights Commission administers compliance with this law.

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