APPLICANT
CO-APPLICANT
Account/Loan : Amount Requested:
**Please include data about Co-Applicant if application is for joint credit with a Co-Applicant or if applicant will rely on
Term:
Purpose/Collateral:
Repayment:
..
First Name : First Name:
Mother's Maiden Name: Mother's Maiden Name:
Account Number: Account Number:
Social Security #: Social Security #:
D/L # : D/L # :
List ages of dependents not listed by other applicant (exclude self) List ages of dependents not listed by other applicant (exclude self)
Date of Birth: Date of Birth:
Home Phone: Home Phone:
Business Phone/Ext.: Business Phone/Ext.:
E-mail Address: E-mail Address:
Present Street Address: Present Street Address:
City/State/Zip: City/State/Zip:
Years at this address: Own Years at this address: Own
Complete for joint credit, secured credit or if you live in a community property state: Complete for joint credit, secured credit or if you live in a community property state:
Applicant Employment/Income
Co-Applicant Employment/Income
Name of Employer: Name of Employer:
Title/Grade: Title/Grade:
Start Date: Start Date:
Hours at Work: Hours at Work:
Supervisor's Name: Supervisor's Name:
If self employed, type of business: If self employed, type of business:
NOTICE: Alimony, child support or separate maintenance income need not be revealed if you do not choose to have it considered. NOTICE: Alimony, child support or separate maintenance income need not be revealed if you do not choose to have it considered.
Gross Income : $ Gross Income : $
Other Income: Other Income:
Source: Source:
Military: Is duty station transfer expected during the next year? Military: Is duty station transfer expected during the next year? N/A Where:
References
Name (nearest relative not living with you): Other Name:
Address: Address:
City/State/ Zip: City/State/ Zip:
Phone: Phone:
Relationship: Relationship:
Financial Information
Asset Information
Other Information About You
State Law Notices
Ohio Residents Only: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy 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.
Wisconsin Residents Only: (1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under Section 766.70 will adversely affect the rights of the credit union unless the credit union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spous. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.
X________________________________________ Signature for Wisconsin residents only
X_______________
By submitting the application, I am authorizing Arizona ATV'S, Inc.
Signatures
You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. If there are any important changes you will notify us in writing immediately. You authorize the credit union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension or collection of the credit received. You understand that the credit union will rely on the information in this application and your credit report to make its decision. If you request, the credit union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.
X________________________________________ Applicant Signature X________________________________________ Co-Applicant Signature
X_______________ X_______________