Applicant'S Statement printable pdf download

SW Counties Employees Credit Union

214 S. Neosho Blvd., Suite B

Neosho, Missouri 64850

APPLICANT'S STATEMENT

Name:_________________________________SSN#:___________________ Driver's License#:_________________ Date of Birth:_______

Address:________________________________________________ City, State, Zip:____________________________________________

Phone:____________________ Number of Dependents:_______ Former Address(if less than 3 years):_____________________________

Employer:_______________________________ Address:___________________________________ Phone#:_______________________

Yrs. of Service:___________ Position:_____________ School:_________________ Supervisor:__________________________________

Gross Salary:$_____________ □Weekly □Bi-weekly □Monthly □Annually Other:$__________Spousal/Child Support:$______________

Former Employer (if less than 4 years at present):______________________________ Address:________________________________

*Spouse's name:_____________________ SSN#:_______________ Driver's License#:___________________Date of Birth:________

Employer:_____________________________Address:_______________________________

Phone#:_______________________

Yrs. of Service:___________ Position:_____________________________ Supervisor:_______________________________

Gross Salary:$_________________ □Weekly □Bi-weekly □Monthly □Annually

Home:□Rent □Own Years there:_____ Present Value:$__________ Landlord (if any):___________________ Phone#:_________________

Monthly pymt. Rent / Mortgage:$_________Pymts.Current? □Yes □No Mortgage Balance:$_________Finance by:____________________

Name of Relative not living with you:__________________Phone#:__________Relationship:__________Address:____________________

Are you a co-maker on any loan? □Yes □No Date:___________Amount:$________ Bankruptcy in last 10 years? □Yes □No Date:_________

Legal proceedings pending against you? □Yes □No Explain:_________________________________________________________________

Credit applied for under another name? □Yes □No If so, give name(s):________________________________________________________

Personal Reference (NO relative):___________________________ Address:_____________________________Phone#:_______________

The statements herein are made for the purpose of obtaining a loan and are true to the best of my knowledge and belief. You are hereby

authorized to make any credit investigation the credit committee deems necessary.

(X)Applicant's Signature____________________________ Joint Signature (if applicable)_________________________

□Share Loan □Signature Loan □Collateral Loan

Purpose:_______________________

Amount Needed:$________________

#Pymts:__________ of $__________

#Pymts:__________ of $_________

#Pymts:__________ of $__________

Payroll deduct □Yes □No Start______

Approved / Not approved

Date:

Cr. Mgr.

Cr. Com.

__________

Applicant'S Statement