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Online Loan Application Form




19530 INTERNATIONAL BLVD S. SUITE 108
SEATAC, WA 98188-5498

LOAN APPLICATION

Married Applicants may apply for a separate account.
Check the appropriate box to indicate individual Credit or Joint Credit.
 Individual Credit:
Complete Applicant sections if only the applicant's income is considered for loan approval. Complete Applicant and Co-Applicant sections: (1) if you are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of credit requested, or; (2) if you reside in a Community Property State, or; (3) if you are relying on property located in a Community Property State as a basis for repayment of the creditrequested. Community Property States include: AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI.
 Joint Credit:
Complete Applicant and Co-Applicant sections if your co-applicant will be contractually liable for repayment of the loan.

PLEASE CHECK BELOW TO INDICATE THE TYPE OF ACCOUNT(S) AND TYPE OF CREDIT FOR WHICH YOU ARE APPLYING.
 Account/Loan: (including ATM/Debit Card Access to the Account if Available)

 Individual  Joint


Amount Requested: $
Purpose/Collateral: 
Other Loan Request:
Repayment:  Payroll Deduction  Billing Notice  Automatic Payment  WebPay  Other


APPLICANT
Name (Last, First, Initial) 
Account Number 
Social Security Number 
Mother's Maiden Name 
E-mail Address 
Fax Number 
Birth Date 
Home Phone 
Business Phone/Ext 
Present Address (Street) 
(City, State, Zip) 
 OWN     RENT
Years/Months at this Address  
Previous Address (Street) 
(City, State, Zip) 
Purchase Price of Home 
Present Home Value 
Mortgage Balance 
Monthly Payment (Mortgage/Rent) 
Please complete the following, only if you are applying for joint credit, secured credit, or if you live in a community property state:
 MARRIED (WA and CA Only -includes registered domestic partners)

 SEPARATED

 UNMARRIED (Single, Divorced, Widowed)

APPLICANT EMPLOYMENT
Name of Employer 
Address of Employer 
Hire Date 
Position 
Prior Employer 

APPLICANT INCOME

OTHER INCOME NOTICE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income (GROSS) 
PER 
Other Income (GROSS) 
PER 
Source 

APPLICANT REFERENCES - NEAREST RELATIVE NOT LIVING WITH YOU
First Name/Last Name   
Address 
City 
State 
Zip 
Home Number 
Relationship 

 CO-APPLICANT

 NON-APPLICANT SPOUSE/OTHER

 GUARANTOR

Name (Last, First, Initial) 
Account Number 
Social Security Number 
Mother's Maiden Name 
E-mail Address 
Fax Number 
Birth Date 
Home Phone 
Business Phone/Ext 
Present Address (Street) 
(City, State, Zip) 
 OWN     RENT
Years/Months at the Address  
Previous Address (Street) 
(City, State, Zip) 
Purchase Price of Home 
Present Home Value 
Mortgage Balance 
Monthly Payment (Mortgage/Rent) 
Please complete the following, only if you are applying for joint credit, secured credit, or if you live in a community property state:
 MARRIED (WA and CA Only -includes registered domestic partners)

 SEPARATED

 UNMARRIED (Single, Divorced, Widowed)

CO-APPLICANT EMPLOYMENT
Name of Employer 
Address of Employer 
Hire Date 
Position 
Prior Employer 

CO-APPLICANT INCOME

OTHER INCOME NOTICE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income (GROSS) 
PER 
Other Income (GROSS) 
PER 
Source 

CO-APPLICANT REFERENCES - NEAREST RELATIVE NOT LIVING WITH YOU
First Name/Last Name   
Address 
City 
State 
Zip 
Home Number 
Relationship 



STATE NOTICES

OHIO RESIDENTS ONLY: 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.

WISCONSIN RESIDENTS: Marital Status:  Married  Unmarried  Legally Separated

If married: the name of my spouse is
Spouse's SSN: Spouse's Address (if different)

Notice: No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under Section 766.70 will adverselyaffect 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.

MARRIED WISCONSIN RESIDENTS APPLYING FOR AN INDIVIDUAL ACCOUNT: By signing here, I state that the credit being applied for, if granted, will be incurred in the interest of the marriage or family of the Borrower(s).

LOAN APPLICATION SIGNATURES

PLEASE READ BEFORE SUBMITTING

All the information in this application is true. I understand that section 1014 Title 18 U.S. Code makes it a federal crime to knowingly make a false statement on this application. You have my permission to check it. You may retain this application even if not approved. I understand that you may receive information from others about my credit and you may answer questions and requests from others seeking credit or experience information about me or my accounts with you. If this application is approved, I agree to honor the provisions of the credit or loan agreement and security agreement covering my account or loan. (If this application is for two of us, this statement applies to both of us.)

Credit Report Authorization. By submitting this Application, I authorize you to obtain my credit report for the purposes of evaluating this application and to obtain subsequent credit reports on an on-going basis in connection with this transaction, and for all other legitimate purposes, such as reviewing my accounts or taking collection action on the account.

Vermont Residents: Applicant provided consent via phone _______________ (Credit Union Initials)

IMPORTANT NOTICE ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for me: When I open an account, you will ask for my name, address, date of birth, and other information that will allow you to identify me. You may also ask to see my driver's license or other identifying information.


HAVE YOU OMITTED ANYTHING? REMEMBER: INCOMPLETE APPLICATIONS CANNOT BE PROCESSED.


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