BALDWIN COUNTY FEDERAL CREDIT UNION

P.O. Box 1149

Bay Minette, AL 36507
Ph; (251) 937-0334. Fax: (251) 580-1609
ffiMM.
ication
Howro ' Please complete front and back of application *copy of 2 most current paystub (Gross rncorne)
APPLY . Sign on back page
. Return completed application to credit union *Ce11 /l
. An incomplete or unsigned application may delay processing

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, lD, LA, NM, NV TX, WA, Wl),
2. your spouse will use the account, or
3. you are relying on your spouse's income as a basis for repayment. lf you are relying on income from alimony, child support, or separate maintenance,
complete the Other section to the e)dent possible about the person on whose payments you are relying.
Joint Credit Each Applicant must individually complete the appropriate seclion below lf Co-Borrower is spouse of the Applicant, mark the Co-Applicant box.
Guarantor: Gomplete the Other section if you are a guarantor on an accounVloan.

D lOA,]rtl-lUgR@ AccounUloan: n lndividual ! Joint Amount Requested $_ Purpose/Collateral:

(lncluding ATM/Debit Card Access to the Account if Available)
Repayment: ! Payroll Deduction fl Cash n Military Allotment n Automatic Payment

l l Single Credit Disability Insurance L-.i Single Credit Life lnsurance Check coverage(s) desired. The credit union will disclose the cost of this

E Joint Credit Life Insurance voluntary insurance to you. A separate insurance election which discloses
the terms and conditions must be signed for coverage to become effective.

LIST AGES OF DEPENDENTS NOT LISTED LIST AGES OF DEPENOENTS NOT LISTED
BY OTHER APPLICANT (Exclude Self) BY APPLICANT (ExcIude SeII)

OATE HOME PHONE BUSINESS PHONE/ EXT. DATE HOME PHONE BUSINESS PHONV EXT.

ADDRESS (Street - City - State - Zip) PRESENT ADDRESS (Street - City - State - Zip)

PREVIOUS ADDRESS (Street - City - State - Zip) PREVIOUS ADDRESS (Street - City - State - Zip)

FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNIry FOR JOINT CHEDIT, SECURED CREDIT OR IFYOU LIVE IN A COMMUNITY
STATE:

NAME AND
ADDHESS OF
EMPLOYER

IF SELF EMPLOYED, TYPE OF BUSINESS IF SELF EMPLOYED, TYPE OF BUSINESS

EMPLOYMENT INCOME OTHER INCOME EMPLOYMENT INCOME OTHER INCOME

$- pen $- prn $- pen $- pen

MILITARY: ISDUTYSTATIoNTRANSFEREXPECTEDDURINGNEXTYEAR? I IYES I INo MILITARY: ISDUrySTATIONTRANSFEREXPECTEDDURING NEXTYEAR? I IYES I INO

WHERE WHERE ENDING/SEPARATION DATE

PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS STARTING DATE PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS STARTING DATE
THAN FIVEYEARS THAN FIVE YEARS

,1
@CUNA MUTUAL GROUB 980, 82, 84, 86, 89, 98, 2001, 03, 08, ALL RIGHTS RESERVED
i#-l*I!iffiH$'e- RELAnoNsHrP
,iffiiFlfifit 1 RELAIoNSHTP
NAME AND ADDRESS NAME AND ADDRESS
OF NEABEST
HOME PHONE HOME PHONE
RELATIVE NoT RELATIVE NOT
LIVING WITH YOU LIVING WITH YOU

CREDITOR NAME OTHERTHANTHIS CREDIT UNION INTEREST OWED BY

(Attach additional sheet(s) if neessary) PRESENT BALANCE MONTHLY PAYMENT
RATE
Applicant Other

f ner'rr ! nnsr
MORTGAGE
rln^|'da Tav .^d lhc \ $ $
2nd MORTGAGE $
1 st AUTO LOAN $ $
2nd AUTO LOAN $ $
CHILD-CARE $ iD

CHILD SUPPORT $ $
CREDIT CARD $ D
CREDIT CARD $ $
OTHER $ $
OTHER $ :b
LIST ANY NAMES UNDER WHICH YOUR CREDIT REFERENCES AND CREDIT HISTORY CAN BE CHECKED: I rOraS I g IE

PLEDGED AS COLLATERAL OI'VNED BY

wha{.Yao.own LIST LOCATION OF PROPERTY OR FINANCIAL INSTITUTION MARKETVALUE
FOR ANOTHER LOAN Applicant Other
HOME s YES NO

AUTO $ YES NO

SAVINGS s YES NO

CHECKING $ YES NO

OTHER (Describe) $ YES NO

. othg,!,f.,919
.. Ahlrrd V6rillon " I|"rFyou ANswER'yEs-ro ANy ouEsrroN orHER rHAN #1, ExpLArN oN AN ATTA.HED sHEEr

1. ARE YOU A U.S. CITIZEN OR PEBMANENT RESIDENT ALIEN?

2. DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY HAD A DEBT ADJUSTMENT
PLAN CONFIRMED UNDER CHAPTER 13, HAD PROPERry FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS. OR BEEN A
PAFITYINAIAWSIIIT?
3. ISYOUR INCOME LIKELYTO DECLINE INTHE NEXTTWOYEARS?

FOR WHOM (Name ol Others Obligated on Loan); TO WHOM (Name ol Creditor):

0Hl0 RESIDENTS 0NLY: The 0hio laws against copy of the agreement, statement or decree, or has actual knowledge of its terms,
discrimination require that all creditors make credit before the credit is granted or the lccount is opened. (2) Please sign if you are not
rrith your spouse. The credit being applied fot if
credit reporting agencies m aintain seoarate credit histories on each individual uoon granted, will be incuned in the inter est ol the marriage or family of the undersigned.
request. The Ohio Civil Righ rs Commission administers compliance with this law.

WISCONSIN RESIDENTS OI ILY: (1) No provision ol any marital property agreement,

tv
unilateral statement under S ection 766.59, or court decree under Section 766.70 will lii
adversely affect the rights c f the Credit Union unless the Credit Union is furnished a SIGNATURE FOR WISCONSIN RESIDEN

Youpromisethateverthingyouhavestatedinthisapp|icationiScorrecttothebeStofCreditUnionwi||re|yonthein|ormationinthisappli
yourknowledgeandthattheaboveinformationisacompletelistingofwhatyouowe. lf itsdecision. lfyourequest,theCreditUnionwill tell youthenameandaddressofany
thereareanyimportantchangesyouwi||notifyusinWritingimmediate|y.Youauthorizecreditbureaufromwhichreoelved
theCreditUniontoobtaincreditreportsinconnectionWiththisapp|icationforcreditand
for any update, renewal or extension ol the credit received. You understand that the to federal credit unions or state chartered credit unions insured by NCUA.

X (.EAL) (SEAL)

DATE OTHER SIGNATURE

APPROVED APPROVED SIGNATURE LINE OF CREDIT OTHER OTHFR

LIMITS:
DENIED (Adverse Action Notice Sent) o b D

SIGNATURES: