Belle River Credit Union: Loan Application

* Required Fields

Purpose of Loan:

Term:

Account Number:

Amout Requested:

This application initiates the loan process. Final signature(s) will be required to advance funds, including signatures for joint applicants. We will contact you the next business day.

PLEASE TELL US ABOUT YOURSELF (PRIMARY BORROWER)

Full Name:

Street Address:

Street Address 2:

City:

State:

ZIP:

Years There:

Home Phone:

Work Phone:

Driver's License Number:

Driver's License State:

Social Security Number:

- -

Birth Date:

/ /

E-Mail Address:

PLEASE TELL US ABOUT YOUR JOB (PRIMARY BORROWER)

Current Employer:

Years There:

Phone Number:

Position:

Gross Montly Income:

Note: alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation

Other Income:

Source:

PLEASE TELL US ABOUT YOURSELF (CO-BORROWER)

Full Name:

Street Address:

Street Address 2:

City:

State:

ZIP:

Years There:

Home Phone:

Work Phone:

Driver's License Number:

Driver's License State:

Social Security Number:

- -

Birth Date:

/ /

E-Mail Address:

PLEASE TELL US ABOUT YOUR JOB (CO-BORROWER)

Current Employer:

Years There:

Phone Number:

Position:

Gross Montly Income:

Note: alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation

Other Income:

Source:

PLEASE LIST NEAREST RELATIVE NOT LIVING WITH YOU

Full Name:

Home Address:

Home Address 2:

City:

State:

ZIP:

Phone Number:

IF APPLYING FOR A PERSONAL UNSECURED LOAN SUCH AS VACATION OR OTHER PLEASE SELECT A FORM OF COLLATERAL

Collateral:

Monthly Payments

Mortgage

Debt Payment:

Payment To:

Monthly Payment:

Balance Owed:

Rent

Debt Payments:

Payment To:

Monthly Payment:

Balance Owed:

Auto

Debt Payment:

Payment To:

Monthly Payment:

Balance Owed:

Auto 2

Debt Payment:

Payment To:

Monthly Payment:

Balance Owed:

Charge Card

Debt Payment:

Payment To:

Monthly Payment:

Balance Owed:

Other

Debt Payment:

Payment To:

Monthly Payment:

Balance Owed:

Other

Debt Payment:

Payment To:

Monthly Payment:

Balance Owed:

Other

Debt Payment:

Payment To:

Monthly Payment:

Balance Owed:

Amount you pay in alimony or child support:

Are you a Co-Borrower on any other loans?

Yes

If yes, for whom:

Where:

Monthly Payment:

AGREEMENT

DISCLAIMER: I/WE HEREBY CERTIFY THAT ALL STATEMENTS MADE ARE TRUE AND COMPLETE, ARE SUBMITTED FOR THE PURPOSE OF OBTAINING CREDIT, AND THAT THE CREDIT UNION MAY RELY ON THEM FOR SUCH DETERMINATION. WE UNDERSTAND THAT FEDERAL LAW REQUIRES THE VERIFICATION OF IDENTIFICATION FOR ALL NEW ACCOUNTS SHOULD I NOT HAVE AN EXISTING ACCOUNT. I/WE AUTHORIZE YOU TO OBTAIN SUCH INFORMATION AS YOU MAY REQUIRE CONCERNING THE STATEMENTS MADE IN THIS APPLICATION AND PROPER IDENTIFICATION, AND AGREE THAT THE APPLICATION SHALL REMAIN YOUR PROPERTY, AND YOU ARE AUTHORIZED TO ANSWER QUESTIONS ABOUT YOUR CREDIT EXPERIENCE WITH ME/US.

I accept:

I accept the terms of the disclaimer above and submit my application.

Security Code:

Belle River Community Credit Union
10636 Gratiot Avenue
P.O. Box 159
Richmond, Michigan 48062
(586) 727-6855
Fax: (586) 727-7460
brccu@comcast.net