Vehicle Loan Application

General

Purpose Purchase Refinance Other

Loan Amount

Term

Who is applying for this loan? Applying solely Joint credit with spouse Joint credit with other

Are you interested in having your loan protected? No Yes

If you answer "yes", the Credit Union will disclose the cost of this voluntary payment protection to you. A separate election which discloses the terms and conditions must be signed for protection to be effective.

Vehicle

Year

Make

Model

Series (i.e. 4x4, GT)

Vehicle ID Number (VIN)

Mileage

Personal

Your First Name

MI

Your Last Name

Date of Birth

Social Security Number

Your Email Address

Your Address Line 1

Your Address Line 2

City

State

ZIP

Date moved to current address (mm/dd/yyyy)

Current Residence Rent Own Other

Monthly Payment

Marital Status Married Unmarried Separated

Your Phone Number

Best time to call Morning Afternoon Evening

Employment

Self Employed No Yes

Current Employer

Employer Address Line 1

Employer Address Line 2

City

State

ZIP

Employer Phone Number

Position or Title

Date of Hire (mm/dd/yyyy)

Gross annual income

Other annual income

Source

Co-Applicant (CA)

Co-Applicant First Name

MI

Co-Applicant Last Name

Co-Applicant Date of Birth

Co-Applicant Social Security Number

Co-Applicant Email Address

Co-Applicant Address Line 1

Co-Applicant Address Line 2

City

State

ZIP

Date moved to current address (mm/dd/yyyy)

Current Residence Rent Own Other

Co-Applicant Monthly Payment

Marital Status Married Unmarried Separated

Phone Number

Best time to call Morning Afternoon Evening

CA Employment

Self Employed No Yes

Co-Applicant Employer

Co-Applicant Employer Address Line 1

Co-Applicant Employer Address Line 2

City

State

ZIP

Co-Applicant Employer Phone Number

Position or Title

Date of Hire (mm/dd/yyyy)

Gross annual income

Other annual income

Source

Assets and Liabilities

Child Support Payments No Yes

Monthly Child Support Amount

Co-Applicant Child Support Payments No Yes

Co-Applicant Monthly Child Support Amount

Home Market Value

Home Debt Amount

Vehicle #1 Year

Vehicle #2 Year

Vehicle #1 Make

Vehicle #2 Make

Vehicle #1 Model

Vehicle #2 Model

Vehicle #1 Lienholder

Vehicle #2 Lienholder

Statement of Understanding

NOTICE TO MARRIED APPLICANT: No provision of a marital property agreement, a unilateral statement under Sis. Stats. sec 766.59 or a court decree under Wis. Stats 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.

This statement is submitted to obtain credit and does not constitute a contract for the extension of credit. I (We) Certify that all the information herein is true and complete. I (We) also authorize the credit union to verify or obtain any additional information the credit union may deem necessary concerning my (our) credit standing with credit bureaus, collection agencies, and any other source for consideration for the loan applied for hereon or for any other service offered as this credit union or its affiliate. The credit union may release information about its credit experience with me (us) as permitted by law. I (We) understand that it may be a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts, as applicable under the provisions of Title 18, United Sates Code, Section 1014.

I have read the statement (above) I agree to this statement