Getting Started*

Individual Credit: Relying solely on my income or assets Joint Credit: We intend to apply for joint credit
If this is an application for joint credit, Applicant and Co-Applicant each agree and acknowledge the intent to apply for joint credit (sign below).
Applicant acknowledgement signature to apply for credit	Date
Amount Requested
$
Credit Limit Requested	If Authorized User, Name
$

Personal Information

Previous Address

Employment/Income

Other Information

These Questions Apply to Both Applicant and Co-Applicant

If you answered yes to the following questions, except for the first one, please use the comment section to explain.
Question	Applicant	Co-Applicant
Are you a U.S. citizen or permanent resident alien?	YesNo	YesNo
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 seven years, or been a party in a lawsuit?	YesNo	YesNo
Is your income likely to decline in the next two years?	YesNo	YesNo
Are you a co-maker or co-signer on any loan?	YesNo	YesNo
For whom? (Name of others obligated on loan)
To whom? (Name of creditor)

State Law Notices

Notice to Nebraska Residents

A credit agreement must be in writing to be enforceable under Nebraska law. To protect you and us from any misunderstandings or disappointments, any contract, promise, undertaking, or offer to forebear repayment of money or to make any other financial accommodation in connection with this loan of money or grant or extension of credit, or any amendment of, cancellation of, waiver of, or substitution for any or all of the terms or provisions of any instrument or document executed in connection with this loan of money or grant or extension of credit, must be in writing to be effective.

Notice to New York Residents

New York residents may contact the New York State Department of Financial Services to obtain a comparative listing of credit card rates, fees, and grace periods. New York State Department of Financial Services: 1-800-342-3736 or www.dfs.ny.gov. Notice to Ohio Residents: 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. 

Notice to Ohio Residents

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.

Notice to Wisconsin Residents

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 for Wisconsin Residents Only	Date

Credit Card Consensual Security Interest

You grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure your credit card account. Shares and deposits in an IRA or any other account that would lose special tax treatment under state or federal law if given as security are not subject to the security interest you have given in your shares and deposits. You may withdraw these other shares unless you are in default. When you are in default, you authorize us to apply the balance in these accounts to any amounts due. For example, if you have an unpaid credit card balance, you agree we may use funds in your account(s) to pay any or all of the unpaid balance.

By signing or otherwise authenticating below, you are affirmatively agreeing that you are aware that granting a security interest is a condition for the credit card and you intend to grant a security interest.

Applicant Signature for Consensual Security Interest Acknowledgement and Agreement	Joint Applicant Signature for Consensual Security Interest Acknowledgement and Agreement
Date	Date

Finishing Up

Comments
* Electronic Communications Disclosure & Consent
Read the Disclosure
ConsentI Do Not Consent
If you do not provide your consent, your online loan application will not be saved and you will be required to contact the Credit Union at 620-345-2980 for alternative loan application options.

Signatures

By signing or otherwise authenticating below:

1. 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. If 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, increase, renewal, extension, or collection of the credit received and for other accounts, products, or services we may offer you or for which you may qualify. 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 crime to willfully and deliberately provide incomplete or incorrect information in this application.
2. If you are applying for a credit card, you understand that the use of your card will constitute acknowledgment of receipt and agreement to the terms of the Consumer Credit Card Agreement and Disclosure.

* Primary Signature		* Date (mm/dd/yyyy)
*Prove you're not a robot.