Loan Application Form

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Member Assisted
PERMACULTURE CREDIT UNION
P.O. Box 29300
Shared Secured
Santa Fe, NM 87592-9300
Loan Application
Phone: (505) 954-3479
Toll Free: (866) 954-3479
Fax: (505) 424-1624 -
Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:
1. you live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI),
2. your spouse will use the account, or
3. you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance,
complete the Other section to the extent possible about the person on whose payments you are relying.
Joint Credit: Each Applicant must individually complete the appropriate section below. If Co-Borrower is spouse of the Applicant, mark the Co-
Applicant box.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.
Individual_______
Joint_____
Amount Requested $___________________
Purpose: ______________________
Repayment: Payroll Deduction___ Cash___ Military Allotment___ Automatic Payment__
Applicant
Other: Co-Applicant__ Spouse__ Guarantor__
Name (Last-First-Initial)
Mother’s Maiden Name
Name (Last-First-Initial)
Mother’s Maiden Name
Account Number
Social Security Number
Account Number
Social Security Number
Drivers License Number/State
List ages of dependents not
Drivers License Number/State
List ages of dependents not
listed by other applicant (exclude
listed by other applicant (exclude
self)
self)
Birth Date
Home Phone
Business Phone
Birth Date
Home Phone
Business Phone
Email Address
Email Address
Present Address (Street-City-State-Zip)
Years at this
Present Address (Street-City-State-Zip)
Years at this
Address
Address
Rent___
Own___
Rent___
Own___
Complete for joint credit, secured credit or if you live in a
Complete for joint credit, secured credit or if you live in a
community property state:
community property state:
Married__ Separated___ Unmarried___
Married__ Separated___ Unmarried___
(Single-Divorced-Widowed)
(Single-Divorced-Widowed)
You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete
listing of what you owe. If there are any important changes you will notify us in writing immediately. You authorize the Credit Union to obtain credit
reports in connection with this application for credit and for any update, increase, renewal, extension or collection of the credit received. You understand
that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell
you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide
incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA. Because this
loan is secured by the Arroyo S.E.C.O. Community Revolving Loan Fund (ASECO CRLF), in the case of default and payment of the loan by ASECO
CRLF, the loan will be assigned to the ASECO CRLF. A loan will be considered in default when it becomes 120 days past due.
____________________________________________
________________________________________
Applicant Signature
Date
Other Signature
Date
FOR CREDIT UNION USE ONLY
Date
Approved_____
Approved Limits and Terms
Denied_______
Loan Officer Comments:
Signatures:
X__________________________________________________ X____________________________________________________
Date
Date

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