Loan Application Form

I. Your Information

Check below to indicate the type of credit for which you are applying.

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

Joint Credit: Each Applicant must individually complete the appropriate section below. If Co-Applicant is spouse of the Applicant, mark the Co-Applicant box.

Individual

Co-Application

If this is an application for joint credit, Applicant and Co-Applicant each agree and acknowledge the intent to apply for joint credit (sign below):

Amount Requested $

Credit Limit Requested $

Purpose / Collateral *

Payment Protection: Are you interested in having your loan protected?

YES NO

Social Security *

First Name *

Middle Name

Last Name *

Date of Birth *

Email Address *

Home Phone

Cell Phone *

Business Phone

Driver's License Number *

Street Address *

Own or Rent *

Own Rent

City *

State *

Zip Code *

Previous Address (Street – City – State – Zip)

Mortgage Owed To

Mortgage Balance

Monthly Payment

Interest Rate

II. Employer Information

Employment Status *

Part Time Full Time

Start Date

Hours Per Week

Employer Name *

Employer Address *

NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.

Employment Income *

Pay Frequency (weekly/biweekly/semi-monthly/monthly/annually) *

Other Income

Other Pay Frequency

Title / Grade

Source (direct deposit / payroll deduction / ACH)

Previous Employer

Previous Employer Address (if employed less than two years)

Previous Employment Start Date

Previous Employment End Date

Military: Is Duty Station Transfer Expected During Next Year? *

Yes No

Where

Ending / Separation Date

CO-APPLICANT

Amount Requested $

Credit Limit Requested $

Purpose / Collateral

Driver's License Number

Payment Protection: Are you interested in having your loan protected?

YES NO

Social Security

First Name

Middle Name

Last Name

Date of Birth

Email Address

Home Phone

Cell Phone

Business Phone

Street Address

Own or Rent

Own Rent

City

State

Zip Code

Previous Address (Street – City – State – Zip)

Mortgage Owed To

Mortgage Balance

Monthly Payment

Interest Rate

CO-APPLICANT: Employer Information

Employment Status

Part Time Full Time

Start Date

Hours Per Week

Employer Name

Employer Address

NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.

Employment Income

Pay Frequency

Other Income

Other Pay Frequency

Title / Grade

Source

Previous Employer

Previous Employer Address

Previous Employment Start Date

Previous Employment End Date

Military: Is Duty Station Transfer Expected During Next Year?

Yes No

Where

Ending / Separation Date

REFERENCE

Name & Address of Nearest Relative Not Living With You *	Relationship *	Home Phone *

WHAT YOU OWE

Debt Type	Creditor Name	Interest Rate	Present Balance	Monthly Payment	Applicant	Other

WHAT YOU OWN

Asset Description	Location / Institution	Market Value	Collateral?	Applicant	Other
			Yes No
			Yes No
			Yes No
			Yes No
			Yes No

OTHER INFORMATION ABOUT YOU

Question	Applicant	Other
1. Are you a U.S. citizen or permanent resident alien? *	Yes No	Yes No
2. Do you have outstanding judgments, bankruptcy, foreclosure, repossession, or lawsuit in last 7 years? *	Yes No	Yes No
3. Is your income likely to decline in the next two years? *	Yes No	Yes No
4. Are you a co-maker, co-signer, or guarantor on any loan not listed above? * To whom (creditor):	Yes No	Yes No

STATE LAW NOTICE(S)

Notice to Nebraska Residents: A credit agreement must be in writing to be enforceable under Nebraska law...

Notice to Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers...

Notice to Wisconsin Residents: (1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse.

Signature for Wisconsin Residents Only: Date:

CONSENT TO CONTACT

By signing below, you authorize Florida A & M University Federal Credit Union to deliver or cause to be delivered to you at the telephone numbers provided above, advertising and telemarketing telephone calls, text messages, and voicemail transmissions using an automatic telephone dialing system and/or an artificial or prerecorded voice.

Applicant's Signature Date

Other Signature Date

SIGNATURES

By signing or otherwise authenticating below, you promise that everything you have stated in this application is correct to the best of your knowledge...

Applicant's Signature * Date

Other Signature Date