Apply Online: Online Consumer Credit Application Note: As of now, all information submitted on this form is unsecure. We will have the capacity to provide encrypted transmissions by the fall. The Federal Equal Credit Oppourtunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national orgin or sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act.

Amount Requested:	$
Number of Months:
Purpose:	Please choose one: New Car/Truck Used Car/Truck ATV Snowmachine Personal Watercraft Motorcycle Vacation Furniture Medical Auto Repairs Recreational Vehicle Home Improvement 1st Mortgage 2nd Mortgage Unsecured/Signature Computer Other
Have Co-Borrower. Don't forget to fill out the Co-borrower form, linked below.
Borrower
Personal
First Name:
Middle Initial:
Last Name:
Email Address:
Mailing Address: (if different from residence address)
Street, PO box, etc.	Apt. no.
City:
State:
Zip Code:	-
Residence Address
Number, Street:	Apt. no.
City:
State:
Zip Code:	-
Time at above address:	Years, Months
Former Address Please enter this information if you have lived at above address less than 3 years.
Number, Street:	Apt. no.
City:
State:
Zip Code:	-
Time at above address:	Years, Months
Social Security Number:
Home Phone Number:
Drivers Licence Number:
Date of Birth:	Month/Day/Year //
Child Support Paid:
Number of dependents, including self:	1 2 3 4 5 6 7
Name, address of nearest relative not living with you:
Name:
Address:
City, State, Zip:	,
Phone Number:	()
Occupation/Income
Current Employer:
Address:
Phone Number
Length of Employment:	Years, Months
Position/Grade:
Monthly net salary:	$
Rotation Date (military only):
ETS Date (military only):
Former Employer:
Position:
Length of employment:	Years, Months
Sources of additional income (stock, real estate, retirement, etc), income recieved from child support, alimony, or maintenance is optional information furnished only if you desire this income to be considered in evaluating your application.
Type of other income:
Source:
Monthly Amount:	$
Deposit Information
Type	Checking Savings Credit Union Savings & Loan Assocoation
Bank Name:
Location:
Account Number:
Approx. Balance:	$
Type	Checking Savings Credit Union Savings & Loan Assocoation
Bank Name:
Location: (if different than above)
Account Number:
Approx. Balance:	$
Type	Checking Savings Credit Union Savings & Loan Assocoation
Bank Name:
Location: (if different than above)
Account Number:
Approx. Balance:	$
Credit Information
Renter Homeowner
Monthly Rent/Mortgage Payment	$
Total Car/Truck Payment:	$
Total Credit Card Payments	$
Other Monthly Payments (Total)	$
If you have a co-borrower, don't forget to fill out the co-borrower information page.