MENU LOG IN BECOME A MEMBER APPLY FOR A LOAN FIND A BRANCH CHECK RATES SEARCH APPLY ONLINE TODAY! Email Address Desired Monthly Payment Requested Loan Amount Type of Loan * Please Select Visa Visa Limit Increase New Automobile Loan Used Automobile Loan Automobile Refinance Motorcycle Loan Recreational Vehicle Loan Boat Signature (Personal) Loan Home Equity Line of Credit Cash Advance Loan Savings Secured Home Purchase Home Refinance Requested Term Repayment Please Select 12 Months 24 Months 36 Months 48 Months 60 Months 72 Months Member Account Number Social Security Number First Name Last Name Street Address Street Address Line 2 City State / Province / Region* Choose AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zip Code Do you Rent Own How many years have you lived at this address? Monthly rent or mortgage payment? Home Phone Number Work Phone Number Marital Status Married Unmarried Separated Date of Birth Number of Dependents Previous Address Line (if at current address less than two years) Previous Address Line 2 City State / Province / Region Choose AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zip Code EMPLOYER INFORMATION Name of Employer Address Previous Address Line 2 City State / Province / Region Choose AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zip Code Gross Monthly Salary Hire Date Postion or Job Title Please list any 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. Include the source and the monthly dollar amount. CO-APPLICANT INFORMATION First Name Last Name Suffix Co-applicant's Social Security Number Date of Birth CO-APPLICANT EMPLOYER INFORMATION Name of Employer Employer's Address Employer's Address Line 2 City State / Province / Region Choose AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zip Code Gross Monthly Salary Hire Date Postion or Job Title GENERAL QUESTIONS Personal Reference #1 Personal Reference #1 First Name Personal Reference #1 Last Name Personal Reference #1 Suffix Personal Reference Relationship Choose Spouse Parent Child Significant Other Friend Personal Reference #1 Phone Number Personal Reference #2 Personal Reference #2 First Name Personal Reference #2 Last Name Personal Reference #2 Suffix Personal Reference Relationship Choose Spouse Parent Child Significant Other Friend Personal Reference #2 Phone Number Have you ever obtained credit under another name? Yes No Have you ever filed for bankruptcy or had a repossession? Yes No Are there any judgements or liens against you? Yes No Do you have any past due bills? Yes No If you answered Yes to any of the above questions, please provide an explanation. Are you interested in protecting your loan? Yes, sign me up! Yes, but I'd like more information Not at this time Terms and Conditions By submitting this application, applicant(s) certifies that the information given is true and correct, and, if married, that all assets and income listed are community property unless otherwise designated. The credit union is authorized to confirm the information and retain the application whether or not it is approved. Further, the Credit Union is authorized to obtain whatever information it needs to verify this information from credit bureaus and other sources and to provide information to others about your account. ADDITIONAL SECURITY: If I have other loans with you, now or in the future, collateral securing those loans may also secure my obligations under this Agreement. I understand that I should read any security agreement I sign in order to determine if the collateral also secures my obligations under this Agreement and any other agreements I have with you. IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the U.S. 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. The credit union utilizes the most current SSL CA 2048-bit encryption technology. However, I understand that by sending this form over the Internet that my personal information may not be secure and I release our Credit Union and all its officials, employees, affiliates, subsidiaries, vendors, and assignees from any liability and/or loss that arises from using this form. If you feel more comfortable, you can print out this form, fill it out and mail it to your nearest branch. If you choose this option, your signature must appear somewhere on this application. Click here for our complete VISA disclosures. I agree to these Terms and Conditions Message/Note Preferred Contact Method? Email Work Phone Home Phone Preferred Language Please Select English Spanish © Copyright Unity One Credit Union. Federally insured by the NCUA.