Dodge Central Credit Union

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LOAN APPLICATION

MEMBER/BORROWER
Name:
Address 1:
City:
State:
Zip Code:
Home Phone #:
SSN:
Date of Birth:
Employer:
Work Phone #:
Date of Hire:
Hourly: $
Monthly Gross: $

CO-BORROWER/CO-SIGNER
Name:
Address 1:
City:
State:
Zip Code:
Home Phone #:
SSN:
Date of Birth:
Employer:
Work Phone #:
Date of Hire:
Hourly: $
Monthly Gross: $

OTHER INCOME
Source:Amount: $

Total Monthly Income: $

Amount requested:

Credit line requested:

Purpose:

Collateral description:

Term of loan in months:

months

Marital status:

Income from alimony/child or spousal support payments need not be revealed unless you want the credit union to consider them as a basis for repayment of debt.

Notice to Wisconsin Residents:
No provision of a marital property agreement, a unilateral statement under Wis. Stat. SEc. 766.59 or a court decree under Wis. Stat. Sec. 766.70 adversely affects the interests of the credit union unless prior to the time the credit is extended, the credit union is furnished with a copy of the agreement, statement or decree, or has actual knowledge of the adverse provision when the obligation to the credit union is incurred.

Have you ever declared bankruptcy?NoYes
Year:Reason:

Rent or mortgage amount:

Rent Mortgage

Please note: Income verification and other information may be required.

I /we agree that, by submitting this application, we certify that the foregoing information has been supplied truthfully, accurately and voluntarily, and therefore authorize this credit union to investigate our creditworthiness, credit history, and financial responsibility through any credit bureau or by any other reasonable means. If I am married, applying for individual credit, and living in a community property state, I certify that the credit being applied for, if granted, will be incurred in the interest of the marriage or family. If this statement applies, we are required by Wisconsin law to notify your spouse by mail if your loan is granted.

Dodge Central Credit Union provides links to other sites. As such, Dodge Central Credit Union is a distributor of information. Dodge Central Credit Union is not in control of the contents, product or service on any of these third party websites.

For general information or other questions: dccu@dodgecentralcu.com