AREA CREDIT UNION
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AREA CREDIT UNION
1401 FAIRFAX ROAD SUITE E-100
KANSAS CITY, KANSAS 66115-1489
PHONE: (913)371-1345
FAX: (913)371-3318
 
DATE
ACCT.NO.
NOTE NO.



(_)SHARE LOAN (_)SIGNATURE LOAN (_)COLLATERAL LOAN (_)CO-MAKER LOAN

APPLICANT'S STATEMENT

I hereby apply for a loan for the following purpose(s)____________________________________________________
Amount Needed $________________Present Balance $____________________
To be repaid in________ payments of $__________ starting_________________
Name________________________ Social Security Number_________________
Address_____________________________ Driver's License Number___________________
City, State, Zip_______________________________ Date of Birth_____________________
Telephone Number___________________ Number of Dependents______________________
Former Address(if less than 3 years at present)__________________________________________________________ _________________________________________________________________________________________________
Employeer_____________________________ Address____________________________________________________
Phone Number_______________ Date of Hire_________ Position______________ Supervisor____________________
Gross Salary $___________ (_)Weekly (_)Bi-weekly (_)Monthly (_)Annually
Former Employer(if less than 4 years at current position)_________________________________________
Address_________________________________________________________________________________
Other Income_____________________________________________________________________________
Spousal Information:
Spouse(Name)_____________________ Spouse Social Security Number__________________________
Employer_________________________ Employer Address______________________________________
Position_________________________ Phone Number__________________________________________
Date of Hire______________________ Annual Salary $_________________________________________
Home: (_)Rent (_)Own Years there_________________ Present Value $___________________________
Landlord's Name(if any)__________________________________ Phone Number____________________
Monthly Payment Rent $___________ Mortgage $___________ Payments up to date? (_)Yes (_)No
Mortgage Balance $__________________ Financed By__________________________________________
Name of Relative(not living with you)__________________________________________________________
Relationship______________________ Address____________________________Phone #__________________
Are you a co-maker on any loan? (_)Yes (_)No Date______________ Amount $_____________
Names of Persons co-signed for____________________________________________________
Have you been declared bankrupt in the last 10 years (_)Yes (_)No Date___________________
Have you any legal proceedings pending against you? (_)Yes (_)No If yes, explain
________________________________________________________________________________________
Have you ever applied for credit under another name? If so, give name_______________________________
Personal Reference(other than relative)________________________ Phone Number___________________

List Creditors, Current Balances and Payment Amounts:
1)
2)
3)
4)
5)
Other than these bills I have:
 

OPTIONAL COLLATERAL OFFERED
(Complete only if credit is to be secured)

AUTOS or TRUCKS


YEAR MAKE MODEL BODY STYLE SERIAL NUMBER NO. CYLINDERS NEW OR USED
             
      Color      
Equipment: Auto Trans. Air Cond. Radio(circle) Power(circle) Roof(circle) Cruise Tilt ABS Brakes
      AM Brake Vinyl      
      FM Steering Sun      
      STE Seat "T"      
      TD Window Moon      
      CD Locks        
Name and Address of Insurance Carrier:
 
MOTORCYCLE Year Make Model Serial Number NO. CYLINDERS
           
BOAT Year Make Model Serial Number
         
MOTOR Year Make Model Serial Number H.P.
           
TRAILER Year Make Model Serial Number
         
RECREATION VEHICLE Year Make Model Serial Number Size
           
OTHER
Are you the sole owner of security offered? (_)Yes (_)No If no, list the other owners who will be required to sign:
 
If you intend to apply for joint credit,both signers inital here:_____ _____
Signature         
Joint Signature(If Applicable)


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