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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

If you are interested in determining a mortgage payment, use our mortgage calculator.
To determine if you qualify for a mortgage, use our mortgage qualifier calculator.

Personal Information

Borrower:
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.

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Name:
Address:
City:	State: Zip:
Phone Number:
Work Number:
Social Security #:

Co-Borrower:
(Married applicants must provide information on their spouse even if applying for individual credit.)

Name:
Address:
City:	State: Zip:
Phone Number:
Work Number:
Social Security #:

Employment Information

Borrower:

Employer:
Position:
Length Held: (years)	Monthly Income: $0,000
Employer's Address:
City:	State: Zip:
Employer's Phone Number:
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

Co-Borrower:

Employer:
Position:
Length Held: (years)	Monthly Income: $0,000
Employer's Address:
City:	State: Zip:
Employer's Phone Number:
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

Credit and Asset Information

Monthly Obligations:

Installment payments:
Revolving payments:
Mortgage Payment/Rent:
Other Obligations:

Assets:

Liquid Assets (cash, savings, etc.):
Stocks, Bonds, Mutual Funds, etc.:
Fixed Assets (real estate, personal property, etc.):

Miscellaneous Property Information
(If you have a property picked out you wish to purchase. This does not obligate you to buy only this property)

Property Address:
City:	State: Zip:
Annual Property Taxes:
Annual Insurance:
Annual condo/PUD fees:

Desired Loan Conditions

Please input the rate of interest, loan amount and the loan term that you expect, for purposes of calculating an estimated monthly payment and loan amount for which you qualify.

Interest Rate:	percent
Loan Amount:	dollars
Term of Loan:	years

Your e-mail address:

Any additional comments you may have:

I/we certify that this information has been supplied truthfully, accurately and voluntarily, and therefore authorize this credit union to investigate our credit worthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means. The credit union may release information about its credit experience with me/us. If this application is for the purpose of encumbering real property, I/we agree to pay all allowable expenses incurred in processing this application whether or not the loan is approved. This application does not constitute a contract for the extension of credit. 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 States Code, Section 1014.

Borrower's Signature ________________________________________________

Date ______________________

Co-Borrower's Signature ________________________________________________

Date ______________________

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COMPLETE THIS SECTION ONLY IF YOU ARE MARRIED AND YOU ARE APPLYING FOR CREDIT SEPARATE FROM YOUR 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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Thank You! Upon receipt of this form we will process your application and get back to you as soon as we can to inform you of your eligibility.

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.

Notice:
Transactions restricted by the federal Unlawful Internet Gambling Enforcement Act are prohibited and should not be processed through commercial accounts at this credit union.

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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