Loan Application Form

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

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

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

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.

Employee Income *

Employee weekly/biweekly/semi-monthly/monthly/annually *

Other Income

Other weekly/biweekly/semi-monthly/monthly/annually

Title/Grade

Source

Previous Employer

Previous Employer Address (if employed less than two years)

Start Date

End Date *

MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR?

Yes No

Where

Ending/Separation Date

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?* For whom: To whom (creditor):	Yes No	Yes No

Notice to Nebraska Residents: A credit agreement must be in writing to be enforceable under Nebraska law. To protect you and us from any misunderstandings or disappointments, any contract, promise, undertaking, or offer to forebear repayment of money or to make any other financial accommodation in connection with this loan of money or grant or extension of credit, or any amendment of, cancellation of, waiver of, or substitution for any or all of the terms or provisions of any instrument or document executed in connection with this loan of money or grant or extension of credit, must be in writing to be effective.

Notice to Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

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. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

Signature for Wisconsin Residents Only: Date:

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. You are not required to sign this authorization or enter into this agreement as a condition of purchasing any property, goods or services. You may withdraw the consent provided herein at any time by any reasonable means.

Applicant’s Signature Date

Other Signature Date

By executing this Application, you agree we and/or our third-party providers, including debt collectors, may contact you by telephone call, text message, or voicemail transmission at any telephone number associated with your account, including wireless telephone numbers (i.e. cell phone numbers) which could result in charges to you, in order to service your account or collect any amounts owed to us, excluding any contacts for advertising and telemarketing purposes as prescribed by law. Further, you agree methods of contact may include use of pre-recorded or artificial voice messages, and/or use of an automatic dialing device. You may withdraw the consent to be contacted on your wireless telephone number(s) at any time by any reasonable means. If you have provided a wireless telephone number(s) on or in connection with any account, you represent and agree you are the wireless subscriber or customary user with respect to the wireless telephone number(s) provided and have the authority to give this consent. Furthermore, you agree to notify us of any change to the wireless telephone number(s) which you have provided to us. In order to help mitigate harm to you and your account, we may contact you on any telephone number associated with your account, including a wireless telephone number (i.e. cell phone number), to deliver to you any messages related to suspected or actual fraudulent activity on your account, data security breaches or identity theft following a data breach, money transfers or any other exigent messages permitted by applicable law. These contacts will not contain any telemarketing, cross-marketing, solicitation, advertising, or debt collection message of any kind. The contacts will be concise and limited in frequency as required by law. You will have an opportunity to opt-out of such communications at the time of delivery.

By signing or otherwise authenticating below, 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 and for other accounts, products, or services we may offer you or for which you may qualify. 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 crime to willfully and deliberately provide incomplete or incorrect information in this application.

Applicant’s Signature* Date

Other Signature* Date

NAME & ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU*	RELATIONSHIP*	HOME PHONE*

DEBT	CREDITOR NAME	INTEREST RATE	PRESENT BALANCE	MONTHLY PAYMENT	APPLICANT	OTHER
Other
Other
Other
Other
Other

ASSET DESCRIPTION	LOCATION / INSTITUTION	MARKET VALUE	COLLATERAL?	APPLICANT	OTHER
			Yes No
			Yes No
			Yes No
			Yes No
			Yes No