HOW TO APPLY
• Please complete sections 1 through 6
• Print form and sign section 7
• Return this application to Telephone Workers’ Credit Union
1. NOTE AND COMPLETE
Married Applicants may apply for a separate account. Check the appropriate
box to indicate Individual Credit or Join Credit.
Individual Credit: Complete Applicant section. Complete Co-Applicant,
Spouse, Guarantor (referred to as “Other”) section: (1) about
your spouse if you live ina community property state (AZ, CA, ID, LA,
NM, NV, TX, WA, WI), or (2) if your spouse will use the Account, or
(3) if there is a guarantor on this account. Please check box to indicate
whom the information is about.
Joint Credit: Provide information about both of you by completing Applicant
and Other section.
Repayment:
Payroll Deduction
Cash oAutomatic Payment
Military Allotment
____________________________
STATEMENT
OF INTENT
Check coverage(s) desired. 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.
Check if desired:
Credit Disability Insurance
Single Credit Life Insurance
Joint Credit Life Insurance
2.
APPLICANT INFORMATION
Please print in ink or type
NAME
(FIRST, MIDDLE, LAST)
DRIVER’S
LICENSE NUMBER/STATE
ACCOUNT
NUMBER
BIRTH
DATE
SOCIAL
SECURITY NUMBER
HOME
PHONE
BUSINESS
PHONE/EXT
PRESENT
ADDRESS (Street – City – State – Zip)
OWN
RENT
YEARS:
PREVIOUS
ADDRESS (Street – City – State – Zip)
OWN
RENT
YEARS:
COMPLETE
FOR JOINT CREDIT, SECURED CREDIT, OR IF YOU LIVE IN A COMMUNITY
PROPERTY STATE: Are you married; separated; or unmarried (single,
divorced or widowed)?
Yes
No
LIST OF AGES OF DEPENDENTS NOT LISTED BY OTHER APPLICANT
CO-APPLICANT
SPOUSE
GUARANTOR
Use “SAA” if information is “Same As Applicant”
NAME
(FIRST, MIDDLE, LAST)
DRIVER’S
LICENSE NUMBER/STATE
ACCOUNT
NUMBER
BIRTH
DATE
SOCIAL
SECURITY NUMBER
HOME
PHONE
BUSINESS
PHONE/EXT
PRESENT
ADDRESS (Street – City – State – Zip)
OWN
RENT
YEARS:
PREVIOUS
ADDRESS (Street – City – State – Zip)
OWN
RENT
YEARS:
COMPLETE
FOR JOINT CREDIT, SECURED CREDIT, OR IF YOU LIVE IN A COMMUNITY
PROPERTY STATE: Are you married; separated; or unmarried (single,
divorced or widowed)?
Yes
No
LIST OF AGES OF DEPENDENTS NOT LISTED BY OTHER APPLICANT
3.
APPLICANT EMPLOYMENT INFORMATION
NAME AND ADDRESS OF EMPLOYER
YOUR TITLE/GRADE
SUPERVISOR’S
NAME
START DATE
HOURS AT WORK
IF SELF EMPLOYED,
TYPE OF BUSINESS
IF EMPLOYED
IN CURRENT POSITION LESS THAN FIVE YEARS, COMPLETE PREVIOUS EMPLOYER
NAME AND ADDRESS
STARTING DATE
ENDING
DATE
Military
IS
DUTY STATION TRANSFER EXPECTED DURING YEAR?
YES
NO
WHERE
ENDING/SEPARATION DATE
3. CO-APPLICANT
EMPLOYMENT INFORMATION
NAME AND ADDRESS OF EMPLOYER
YOUR TITLE/GRADE
SUPERVISOR’S
NAME
START DATE
HOURS AT WORK
IF SELF EMPLOYED,
TYPE OF BUSINESS
IF EMPLOYED
IN CURRENT POSITION LESS THAN FIVE YEARS, COMPLETE PREVIOUS EMPLOYER
NAME AND ADDRESS
STARTING DATE
ENDING
DATE
Military
IS
DUTY STATION TRANSFER EXPECTED DURING YEAR?
YES
NO
WHERE
ENDING/SEPARATION DATE
4. APPLICANT
REFERENCES
Please include
State, City, State and Zip.
NAME AND ADDRESS
OF CREDITOR(S) OF DEBTS PAID OFF
TELEPHONE
NAME AND ADDRESS
OF CREDITOR(S) OF DEBTS PAID OFF
TELEPHONE
NAME AND ADDRESS
OF NEAREST RELATIVE NOT LIVING WITH YOU RELATIONSHIP
HOME PHONE
NAME AND ADDRESS
OF PERSONAL FRIEND – NOT A RELATIVE
HOME PHONE
4. CO-APPLICANT
REFERENCES
Please include
State, City, State and Zip.
NAME AND ADDRESS
OF CREDITOR(S) OF DEBTS PAID OFF
TELEPHONE
NAME AND ADDRESS
OF CREDITOR(S) OF DEBTS PAID OFF
TELEPHONE
NAME AND ADDRESS
OF NEAREST RELATIVE NOT LIVING WITH YOU RELATIONSHIP
HOME PHONE
NAME AND ADDRESS
OF PERSONAL FRIEND – NOT A RELATIVE
HOME PHONE
5.
APPLICANT INCOME INFORMATION
Notice:
Alimony, child support, or separate maintenance income
need not be revealed if you do not choose to have it considered.
EMPLOYMENT
INCOME
OTHER
INCOME
$
PER
$
PER
5.
CO-APPLICANT INCOME INFORMATION
EMPLOYMENT
INCOME
OTHER
INCOME
$
PER
$
PER
6.
FINANCIALINFORMATION
These questions apply to both Applicant and Other
IF A “YES”
ANSWER IS GIVEN TO A QUESTION, PLEASE EXPLAIN ON AN ATTACHED SHEET
APPLICANT
OTHER
YES
NO
YES
NO
DO
YOU HAVE ANY OUTSTANDING JUDGEMENTS?
HAVE YOU EVER FILED FOR BANKRUPTCY OR HAD A DEBT ADJUSTMENT PLAN
CONFIRMED UNDER CHAPTER 13?
HAVE YOU HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST
7 YEARS?
ARE
YOU A PARTY IN A LAWSUIT?
ARE
YOU OTHER THAN A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN?
IS
YOUR INCOME LIKELY TO DECLINE IN THE NEXT TWO YEARS?
ARE
YOU A CO-MAKER, CO-SIGNER, OR GUARANTOR ON ANY OTHER LOAN?
FOR
WHOM: (Name of Others Obligated on Loan):
TO
WHOM (Name of Creditor):
7.
SIGNATURES If there are any important changes, you will notify
us in writing immediately. You also agree to notify us of any changes
in your name, address or employment within a reasonable time thereafter.
You also 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 all your debts and obligations.
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.
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.
You understand that it is a federal crime to willfully and deliberately
provide incomplete or incorrect information on loan application made
to Federal Credit Unions or State Chartered Credit Unions insured by
the NCUA.
Please
print out this form, sign, and mail to:
Telephone Workers’ Credit Union
100 High Street
Boston, MA 02110-2326