Loan Application

What's in Your Credit Report?

Kansans can request a free copy of their credit report by going to www.annualcreditreport.com. The three major consumer reporting agencies - Experian, Equifax and TransUnion are offering a free copy of your credit report to help consumers better understand their credit. Knowing what is in your credit report can help catch errors or even alert you of possible fraud or identity theft!

Loan Application

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Please Enter your Email Address:

Married applicants may apply for a separate account. If you are applying for Individual or Joint Credit, you must complete the Applicant section about yourself and the Co-Applicant section about your spouse.

Married Separated Unmarried (Single, Divorced, Widowed)

Type of Loan Applied For:
Personal (Signature) Share Secured New Car Used Car Special Loan
Other:

Amount applied for: $
Purpose:
Desired Length of Repayment (mon):

Method of Payment:
Payroll Deduction Automatic Transfer from Savings Checking

Payment Protection Plan:
Would you like to purchase Credit Life Insurance:
Single Credit Life, (Only Available for Applicant)
Joint Credit Life,
None

Would you like to purchase Credit Disability Insurance:
Single Credit Disability (Only Available for Applicant)
None

Are you a U.S. Citizen?
Yes No

Have you ever had a judgment, bankruptcy, repossesion, or lawsuit?
Yes No

Applicant: Name: Account #: Social Security #: Birthdate (MM/DD/YY): Home Phone #: Cell Phone #: Present Address: Street: City: State & Zip: Current Address since: (MM/YY) If less than 3 yrs enter previous address:	Joint Applicant: Name: Account #: Social Security #: Birthdate (MM/DD/YY): Home Phone #: Present Address: Street: City: State & Zip: Current Address since: (MM/YY) If less than 3 yrs enter previous address:
References not living with member Name: Address: Phone Number: Relationship to Member:

Employer Name: Employer Phone #: Employer Address: Position: Date Hired (MM/DD/YY): Monthly Gross Income: $ Other Income: $ per Month	Employer Name: Employer Phone #: Employer Address: Position: Date Hired (MM/DD/YY): Monthly Gross Income: $ Other Income: $ per Month
NOTE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for this credit request.
Complete if current employment is less than 2 years: Previous Employers Name: Years Employed:	Complete if current employment is less than 2 years: Previous Employers Name: Years Employed:

Credit Information
Please list all open Accounts with a balance.

Creditor	Monthly Payment

Housing Rent Own None

Creditor	Monthly Payment

Housing Rent Own None

Additional Comments or Information:

General Disclosure Statement

Please read the disclosure information below. I/We hereby certify that all statements made are true and complete, are submitted for the purpose of obtaining credit, and that the lender may rely on them for the determination of creditworthiness. I/We authorize you to obtain such information as you may require concerning the statements made in this loan application, agree that the application shall remain your property, and you are authorized to answer questions about your credit experience with me/us. By checking the "I Agree with the statement above" checkbox and clicking the [Submit] button, the applicant(s) authorizes this loan application to be processed by the lender including but not limited to, obtaining the applicant(s) credit history, contacting employer(s) to verify employment, verifying income and assets, and verifying the accuracy of statements contained therein. If my application is approved, I agree to be bound by the terms and conditions disclosed in the consumer loan agreement and disclosure(s) which will be sent to me and authorize the lender to share experience on this account with the consumer credit reporting agencies.

I agree with the statement above.

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Branch Office

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What's in Your Credit Report?

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Applicant:

Joint Applicant:

General Disclosure Statement