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.


SECURE LOAN APPLICATION


  Amount of Loan

$

*
  Purpose of Loan   *
  Applying for  
  If Vehicle, Enter Year  
 

Length of Repayment

  Months

 

Check coverage(s) desired below.  The credit union will disclose the cost of this voluntary insurance to you.  A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.

Life Insurance 

Disability Insurance

GAP Wise 


SOME INFORMATION ABOUT YOU (Applicant)


  Member's Name   *
  Home Phone   *
  Email   *
Date of Birth *
Social Security Number  *
  Account Number   *

Present Address


  Street   *
  City   *
  State   *
  Zip   *
  When did you move in?  

Previous Address
 
Street
City
State
Zip
How long did you live at that address?
 

Your Present Employer


  Employer's Name   *
  Position   *
  Hire Date   *

Your Previous Employer
 
Previous Employer's Name
Position
Start Date
End Date
 

Applicant's Income and Expenses


Gross Monthly Income

$

*
Amount for Monthly Rent/Mortgage

$

*
Other Monthly Payments

$

*
Current financial institution banking with  

Applicant's References
 
Reference's name
Reference's Phone Number
Relationship to Reference
 

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  
Social Security Number
  Date of Birth  
Account Number

Co-Applicant's Address


  Street  
  City  
  State  
  Zip  
  When did you move in?  

Co-Applicant's Previous Address
 
Street
City
State
Zip
How long did you live at that address?
 

Co-Applicant's Present Employer


  Employer's Name  
  Position  
  Hire Date  

Co-Applicant's Previous Employer
 
Employer's Name
Position
Start Date
End Date
 

Co-Applicant's Income and Expenses 


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




Current financial institution banking with  

Co-Applicant's References
 
Reference's name
Reference's Phone Number
Relationship to Reference
 

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.

 
 
         
Comments or Questions:        
         
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?      
         


Brewster Federal Credit Union Loan Application.
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