TYPE AND AMOUNT OF CREDIT YOU'RE REQUESTING:

All loans are subject to credit approval.

This is not a complete loan application and a representative from the Credit Union will be in contact with you for more details on this loan request. Loan disclosures will be provided to you before you sign any loan documents.

NOTICE TO OHIO RESIDENTS: The Ohio laws against discrimination require all creditors make credit equally available to all credit worthy 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.

By submitting this loan request, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment.

By submitting this Internet loan request, I/We authorize First Choice America Community Federal Credit Union to obtain a consumer report and/or a credit report in conjunction with my/our request to:

First Name: *

Initial:

Last Name: *

CU Account Number *

Social Security Number (include dashes) * 🛈

Birth Date: * +

Address: *

City: *

State: *

Zip Code: *

Home/Cell Phone (area code)5551212: * 🛈

Work phone (area code)5551212: * 🛈

Amount Requested: *

Loan Type: *

Loan Term(months): *

Do you want your loan protected for you and your family if you become disabled? *

Do you want your loan protected for your family in the event of your death? *

Driver's License #: *

Driver's License State: *

Current Employer: *

No. of Years With Current Employer: *

Current Supervisior:

Position:

Current Employer Address: *

Current Employer City: *

State: *

Zip Code: *

GMI (Gross Monthly Income): *

Hours per week: *

Hourly/Salary: * 🛈

Frequency of Pay: *

Email for Response:

Confirm

Personal References: (name, address, phone) *

Family References:(name, address, phone, and relationship) *

Housing status: *

How Long(years): *

Monthly payment: *

Name(s) on Deed: *

Market Value: *

Vehicles Owned: *

Vehicles Owned (additional):

**Applicant: Please indicate your marital status:

Marital status: *

Are you applying for joint credit?

Joint Credit?: *

Status for Loan: *