CBS Employees FCU

Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:

you live in or the property pledged as collateral is located in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI),
your spouse will use the account, or
you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about the person on whose payments you are relying.

Joint Credit: If you are applying with another person, complete the Applicant and Other sections.

Guarantor: Complete the Other section if you are a guarantor on an account/loan.

Check below to indicate the type of account(s) and type of credit for which you are applying. *
Married Applicants may apply for a separate account.

Individual Joint

Amount Requested $	Purpose/Collateral
(Including ATM/Debit Card Access to the Account if Available)
Payroll Deduction Automatic Payment Coupons

Applicant

Other: Co-Applicnat Spouse Guarantor

Name * ( Last - First - Initial)	Mother's Maiden Name *
Account # *	Social Security # *
Driver's License # State	Dependents Ages (Excluding Self)
Date of Birth *	Home Phone # *
Work Phone #	E-mail *
Current Street Address *	apt. #
City * State *	Zip
own rent	years at this address
Former Street Address (If current address less than 2 yrs)	apt. No.
City State	Zip
own rent	years at this address
Complete for joint credit, secured credit or if you live in a community property state Married Separated Unmarried

Name ( Last - First - Initial)	Mother's Maiden Name
Account #	Social Security #
Driver's License # State	Dependents Ages (Excluding Self)
Date of Birth	Home Phone #
Work Phone #	E-mail
Current Street Address	apt. #
City State	Zip
own rent	years at this address
Former Street Address (If current address less than 2 yrs)	apt. No.
City State	Zip
own rent	years at this address
Complete for joint credit, secured credit or if you live in a community property state Married Separated Unmarried

Employment/Income

Present Employer	Position/Grade
Address(Street,city,state,zip)	Hours at Work
Date Employed	Supervisor's Name
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.
Income	per
net gross
Other Income Amount $	per
source
Previous Employer	Start date
Address(Street,city,state,zip)	End date

Present Employer	Position/Grade
Address(Street,city,state,zip)	Hours at Work
Date Employed	Supervisor's Name
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.
Income	per
net gross
Other Income Amount $	per
source
Previous Employer	Start date
Address(Street,city,state,zip)	End date

References

Nearest relative name (not living with you)	(Street,City,State,Zip)
Relationship	Home Phone

Nearest relative name (not living with you)	(Street,City,State,Zip)
Relationship	Home Phone

What you owe

Owed by:		Type of Loan	Creditor Other than	Interest rate	Balance	Monthly
Applicant	Other		this credit union			Payments
		Rent Mortgage			$	$
		2nd Mortgage			$	$
		1st Auto Loan			$	$
		2nd Auto Loan			$	$
		Child Care			$	$
		Child Support			$	$
		Credit Card			$	$
		Credit Card			$	$
					$	$
					$	$

What you own

Owned by:		Type	Location or Financial Institution	Market Value	Pledged as collateral for another loan
Applicant	Other				Yes	No
		Home
		Auto
		Savings
		Checking

Other Information About You

		Applicant		Other
		Yes	No	Yes	No
1.	Are you a U.S. Citizen or Permanent Resident Alien?
2.	Do you currently have any outstanding judgments or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit?
3.	Is your income likely to decline in the next two years?
4.	Are you a comaker, cosigner or guarantor on any loan not listed above?
For whom To whom

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 spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

__________________________________________________________________________________
Signature of Member	Date

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. I f 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, renewal or extension 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.

_______________________________________		_______________________________________
Signature of Applicant	Date	Signature of Other	Date

* all marked fields are required information

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