INSTRUCTIONS

Please fill out the following information and press the "Submit Application" button
at the bottom. All questions with an "*" are required.
Your application will then be emailed directly to our loan department.

The information in this application you are about to send will be encrypted for security purposes. 

Click Here for Advance Information for Line of Credit


SECURE LOAN APPLICATION


  Amount of Loan

$

*
  Purpose of Loan   *
Reason (if Signature)
  Applying for  
  If Vehicle, Enter Year  

If Vehicle, Make and Model

If Vehicle, Enter VIN#

 

Length of Repayment

  Months

Repayment Option

Credit Life Insurance

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Credit Disability Insurance

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GAP Wise 

What's this?
Auto Exam (Extended Warranty)
What's this?


Call us for your report. Only $19.99!


SOME INFORMATION ABOUT YOU (Applicant)


  Member's Name   *
  Home Phone   *
  Email   *
Date of Birth *

Present Address


  Street   *
  City   *
  State   *
  Zip   *
  Time and current residence   Years Months

Your Present Employer


  Employer's Name   *
  Position   *
  Hire Date   *
  Self-Employed?  
       
Your Previous Employer
       
  Previous Employer's Name  
  Start Date  
  End Date  
  Reason for leaving  
       

Applicant's Income and Expenses


Gross Monthly Income

$

*
Other Monthly Income $
Source of Other Income  
 

Monthly Expenses Balance Payments First 4 Digits of Card No.
Mortgage/Rent $ $  
2nd Mortgage/Home Equity $ $  
Auto #1 $ $  
Auto #2 $ $  
Child Support/Alimony $ $  
Credit Card $ $
Credit Card $ $
Other $ $
Other $ $
Other $ $

ARE YOU APPLYING WITH ANOTHER PERSON? (Co-Applicant for joint credit)
If not, you may skip down to the end.


  Co-Applicant's Name  
  Home Phone  
  Date of Birth  

Co-Applicant's Address


  Street  
  City  
  State  
  Zip  
  Time and current residence   Years   Months
 

Co-Applicant's Present Employer


  Employer's Name  
  Position  
  Hire Date  
  Self-Employed?  

Co-Applicant's Previous Employer
 
Previous Employer's Name
Start Date
End Date
Reason for leaving
 
 

Co-Applicant's Income and Expenses 


Gross Monthly Income $
Other Monthly Income $
Other Monthly Income Source  
     
Co-Applicant's Monthly Debt - Not Listed Above





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

 
 
    Applicant Co-Applicant  
         
Do you have any outstanding judgments?    
Have you ever filed for bankruptcy?    
Have you had property foreclosed/repossessed?    
Are you a party in a lawsuit?    
Are you other than a U.S. Citizen or permanent resident alien?    
         
Member: I Hereby Attest that the Above Information Is True      
Co-Applicant: I Hereby Attest that the Above Information Is True      
         
How would you like us to contact you?      
If telephone, what is your daytime number?      
         
         
         
         
Comments or Questions:        

Canton Police & Firemen's Credit Union Secure Loan Application.
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