Loan Application

Important Information 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 you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

Please provide all of the requested information. When you have completed this
application print it out, sign it, and drop it off or mail/fax to:

Co-op Credit Union
Attention Loan Department
100 East Main Street
PO Box 157
Black River Falls, WI 54615
Phone: 715-284-5333 or 800-258-0023
Fax: 715-284-5112

Amount requested     
Purpose           
Security          
Length of Loan

We intend to apply for joint credit? Yes  or No
(Married applicants must provide information on their spouse even if 
applying for individual credit.)

Notice to Married Applicant:  No provision of a marital 
property agreement, a unilateral statement under Wis. Stat. sec. 
766.59 or a court decree under Wis. Stat. 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.

Primary Applicant


            Last Name  First Name 

    Social Security #    Date of Birth 

              Address 

                 City   State   ZIP code 

           Home Phone   

        Employer Name 

Employer Phone Number 

       Job Start Date   Month/Year

         Gross Income   Hourly Monthly Annually
	 
            Job Title  

         Other Income 
	Alimony, child support or separate maintenance income need not be 
	revealed if you do not wish to have it considered as a basis for repaying 
	this obligation.  If revealed, it is being received under:
	Court order	Written Agreement	Oral agreement 


Joint Applicant (if applicable)


             Last Name  First Name 

    Social Security #    Date of Birth 

              Address 

                 City   State   Zip Code 

           Home Phone   

        Employer Name 

Employer Phone Number 

       Job Start Date   Month/Year

         Gross Income   Hourly Monthly Annually

            Job Title 

         Other Income  

	Alimony, child support or separate maintenance income need not be
	revealed if you do not wish to have it considered as a basis for
	repaying this obligation.  If revealed, it is being received under:
	court order	written agreement	oral agreement

Debts/ Monthly Payments

In addition to Rent/Mortgage list all other debts (auto loans, etc.)

Financial Assets (checking, savings, stocks, bonds, etc.)
List name, and average balance

Please note: Income verification is required;
other information may be required.

Alimony, child support, or separate maintenance income need not be listed unless you choose to have such income considered regarding extension and repayment of the credit requested.

I/We agree that the credit union may use credit reporting agencies or otherwise verify the information on the request. I/We certify that statements on this application are true and complete.

Primary Applicant's Signature: Date:

Co Applicant's Signature:    Date:

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COMPLETE THIS SECTION ONLY IF YOU ARE MARRIED AND YOU ARE APPLYING FOR CREDIT SEPARATE FROM SPOUSE

I certify that the credit being applied for, if granted, will be incurred or obtained during marriage and will be in the interest of the marriage or family. This      statement is made in accordance with Wis. Stat.sec. 766.55(1).

_________________________________                          _______________
Applicant's Signature                                                               Date

If this section applies, we are required by Wisconsin law to notify your spouse by mail if your loan is granted.
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Day Time Phone

Comments:

For your convenience, this site includes links to other 3rd parties. Co-op Credit Union does not endorse or guarantee these 3rd party sites. The products and services offered on 3rd party sites, including investment and insurance products, are not products of Co-op Credit Union and may be insured by the NCUA or FDIC. Co-op Credit Union does not maintain or control privacy or security on these sites, and as such, makes no guarantees as to the privacy of any information you may provide or disclose while on these sites.

Copyright 2005 Co-op Credit Union
100 East Main Street PO Box 157
Black River Falls, WI 54615
715-284-5333 or 800-258-0023

Questions or comments, please contact us

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