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Loan Details

Account Number

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Loan Amount

Affordable Monthly Payment

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Loan Purpose

Other Purpose Description

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Briefly describe the purpose for this loan application.

Term Months

Identity Information

First Name

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Middle Initial

Last Name

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Social Security Number

Driver's License #

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Driver's License State

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This field is invalid

Birthdate

Contact Information

Preferred Contact Method

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Primary Phone

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Select

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Current Address

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City

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State

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Zip

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Select Occupancy Type

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Monthly Housing Payment

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Years At Current Address

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Previous Address

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City

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State

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Zip

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Employment Information

Monthly Gross Income

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Employment Status

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Current Employer

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Position

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Employer City

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Employer State

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Hours Worked Per Week

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Start Date

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Previous Employer

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Position

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Previous Employment Start Date

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Previous Employment End Date

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Other Monthly Income

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You do not need to include alimony, child support, or separate maintenance if you do not wish to have it relied upon for this application.

Additional Information

Have you ever filed for bankruptcy or had a debt adjustment plan confirmed under Chapter 13?

Yes

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Do you have outstanding judgements?

Yes

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Are you party in a lawsuit?

Yes

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Have you had property foreclosed upon or given a deed in lieu of foreclosure in the last 7 years?

Yes

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Is any income you have listed likely to reduce in the next 2 years?

Yes

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Are you other than a U.S. Citizen or Permanent Resident Alien?

Yes - Not a US Citizen or Permanent Resident Alien

No - US Citizen or Permanent Resident Alien

Special Offers

Yes, I am interested in Credit Life and Disability insurance.

Would you like extra protection for your loan?

Optional Credit Life and Disability Insurance, underwritten by CMFG Life Insurance Company, may pay your loan balance or payments in case of a covered life event.

Life is wonderful, but it isn't always easy. When times get tough, feel confident that you're prepared. In case of an unexpected life event, Credit Life and Credit Disability Insurance helps with your covered loan payments so your loved ones can focus on you.

CDCL-5036213.2-1124-0127 © TruStage | Important Disclosures

Add Co-applicant?

Co-Applicant Identity Information

First Name

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Middle Initial

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Last Name

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Social Security Number

Driver's License #

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Driver's License State

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This field is invalid

Birthdate

Co-Applicant Contact Information

Preferred Contact Method

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Primary Phone

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Select

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Current Address

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City

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State

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Zip

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Select Occupancy Type

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Monthly Housing Payment

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Years At Current Address

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Previous Address

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City

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State

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Zip

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Co-Applicant Employment Information

Monthly Gross Income

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Employment Status

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Current Employer

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Position

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Employer City

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Employer State

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Hours Worked Per Week

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Start Date

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Previous Employer

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Position

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Previous Employment Start Date

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Previous Employment End Date

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Co-Applicant Additional Information

Have you ever filed for bankruptcy or had a debt adjustment plan confirmed under Chapter 13?

Yes

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Do you have outstanding judgements?

Yes

{{getError('coapplicant.has_judgement','Please enter a valid value.')}}

Are you party in a lawsuit?

Yes

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Have you had property foreclosed upon or given a deed in lieu of foreclosure in the last 7 years?

Yes

{{getError('coapplicant.has_past_foreclosure','Please enter a valid value.')}}

Is any income you have listed likely to reduce in the next 2 years?

Yes

{{getError('coapplicant.has_income_may_decline','Please enter a valid value.')}}

Are you other than a U.S. Citizen or Permanent Resident Alien?

Yes - Not a US Citizen or Permanent Resident Alien

No - US Citizen or Permanent Resident Alien

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I, {{primary.first_name}} {{primary.last_name}}, agree to the terms, conditions, and disclosures of this request as the Primary Applicant.

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By checking the box above and submitting this request, all parties named are agreeing to the terms, conditions and disclosures associated with this request.

Disclosures

Credit Report Authorization: By submitting this request, you authorize the Credit Union to obtain credit reports in connection with this request 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 information in this request and your credit report to make its decision. When applicable, spousal information may be requested as a part of this request. 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.

Accuracy of Information: It is a crime to willfully and deliberately provide incomplete or incorrect information in this request.