LOAN AMOUNT REQUESTED

TO BE REPAID IN (estimated)

 REQUESTED PERIODIC PAYMENT

PURPOSE OF LOAN AND COLLATERAL OFFERED

APPLICATION FOR ALL CREDIT

$

MONTHS

$

 OPEN END
 CLOSED END

 CREDIT CARD

THIS APPLICATION IS FOR (Check one of the boxes below):

NOTICE:  MARRIED APPLICANTS MAY APPLY FOR INDIVIDUAL CREDIT

    AN INDIVIDUAL ACCOUNT

    A JOINT LOAN/ACCOUNT WITH MY SPOUSE      A JOINT LOAN/ACCOUNT WITH A CO-APPLICANT

MUST SIGN BELOW

I intend to apply for joint credit. Applicant Signature X______________________________________________________ Co-Applicant Signature X__________________________________________________________
Complete applicant section.  Complete spouse/co-applicant section  if (1) this is to be a joint account with my spouse, (2) my spouse will use this account, (3) I live in a community property state (Alaska, Arizona, California, Idaho, Louisiana, Nevada,
New Mexico, Texas, Washington, Wisconsin or Puerto Rico), or (4) I am relying on my spouse’s income in applying for this account. This section must also be completed about my co-applicant if this is for a joint account with someone other than my spouse.

APPLICANT SECTION
Name

Member Number

Spouse/Other Applicant's Name

Member Number

SPOUSE 

 OTHER APPLICANT SECTION  

 GUARANTOR

Street Address

Street Address

City, State,  Zip

How Long

City, State,  Zip

Social Security Number

Yrs.         Mos.

Date of Birth

Social Security Number

My Home Phone No.

My Work No.

My Home Phone No.

(         )

Street Address (Previous Address)

(         )

(         )

Street Address (Previous Address)

City, State, Zip

How Long

City, State, Zip

Employer (If Part Time, # of Hrs. Wkly_____________)

Employer (If Part Time, # of Hrs. Wkly_____________)

Yrs.         Mos.

How Long

Yrs.         Mos.

Date of Birth

My Work No.

(         )

How Long

Yrs.         Mos.

Employer’s Address (City & State)

Date Employed

Employer’s Address (City & State)

Date Employed

Job Title

Supervisor's Name & Phone No.

Job Title

Supervisor's Name & Phone No.

Applicant's Salary

Weekly

Monthly

Former Employer

Gross $________________

$________________

Weekly

Monthly

Gross $________________

$________________

Additional Income & Source

Other Applicant's Salary

Additional Income & Source

Dates Employed

Former Employer

Dates Employed

Nearest Relative’s Name (not living with me)

Phone No.

Nearest Relative’s Name (not living with me)

Phone No.

From:

          To:

From:

          To:

Relative’s Address & their relationship to me (father, mother, etc.) ___________________

Relative’s Address & their relationship to me (father, mother, etc.) ___________________

(         )

(         )

Personal Reference

Address

Phone No.

(         )

Personal Reference

Address

Phone No.

(         )

Alimony, child support, or separate maintenance need not be revealed if I do not wish to have
it considered as a basis for repaying obligations under this contract.

Alimony, child support, or separate maintenance need not be revealed if I do not wish to
have it considered as a basis for repaying obligations under this contract.

PROOF OF INCOME IS REQUIRED (pay stub, income tax form 1040 or W-2)

© ConmarSystems, Inc., Peachtree City, GA 30269—CFS 13495  Rev. 2/10  ORDER DATE:

TotaLoanTM

TO BE REPRODUCED ONLY
BY PERMISSION OF
CONMAR SYSTEMS, INC.

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FINANCIAL OBLIGATIONS OF BOTH APPLICANT AND CO-APPLICANT—PLEASE INCLUDE ALL OBLIGATIONS - USE SEPARATE SHEET IF NECESSARY

Residence:

I live in a ____house,____apartment,____condo or____mobile home. (Please check one)

I____Own,____Rent,____or Live with relatives.

Vehicle #1

    Yr.

               Make:

             Model:

      Financed With:

Vehicle #2

    Yr.

               Make:

             Model:

      Financed With:

List all obligations including Credit Cards (if there is not sufficient space, attach a separate sheet)

Balance

Monthly Payment

Interest Rate

Alimony/Child Support  (Check one, if applicable)

Court Ordered

Written Agreement

Oral Understanding

I AUTHORIZE THE USE OF ALL ELECTRONIC SIGNATURES, FACSIMILE SIGNATURES AND PHOTOCOPIED SIGNATURES FOR ALL PURPOSES, SAID SIGNATURES
TO HAVE THE SAME FORCE AND EFFECT AS ORIGINAL SIGNATURES FOR ALL TRANSACTIONS, INCLUDED IN APPLICATIONS OR AGREEMENTS WITH YOU.
I grant permission to you to garnish head of family earnings, if collection proceedings are brought against me.
 If you reasonably determine any stock pledged as Collateral under any stock secured loan has become insufficient to fully secure my obligations under this Note  by reason of a decline
in the market value thereof, I must either (i) pledge additional stock in an amount you deem sufficient to fully secure my outstanding Sub-Account balance, or (ii) reduce my outstanding
Sub-Account balance (by prepayment) so that the stock previously pledged is sufficient to fully secure my outstanding loan balance.
It is the Credit Union's policy to not discriminate against any applicant with respect to race, color, religion, national origin, sex, marital status, age, the receipt of public assistance, part
time income, or exercising rights under any consumer protection credit act. In addition, it is our policy not to discriminate based on familial status or a handicap in the extension of
credit for housing. It is the Credit Union's intent to comply with all consumer credit protection statutes and regulations.
I  AGREE  THAT  EVERYTHING  STATED  IN  THIS  APPLICATION  WHETHER  ORAL,  WRITTEN,  OR  THROUGH  A  FAX  MACHINE  IS  CORRECT  TO  THE  BEST  OF  MY
KNOWLEDGE. THE CREDIT UNION IS AUTHORIZED TO INVESTIGATE MY CREDIT-WORTHINESS, EMPLOYMENT HISTORY, AND TO OBTAIN A CREDIT REPORT AND
TO ANSWER QUESTIONS ABOUT THEIR CREDIT EXPERIENCE WITH ME. I UNDERSTAND THAT ANY FALSE OR MISLEADING STATEMENTS IN MY APPLICATION MAY
CAUSE ANY LOAN OR EXTENSION TO BE IN DEFAULT. I UNDERSTAND THAT 18 U.S.C. §1014 MAKES IT A FEDERAL CRIME TO KNOWINGLY MAKE ANY FALSE
STATEMENT ON THIS APPLICATION.
The USA Patriot Act requires that you verify the identity of all account holders. You may ask me or my co-applicant to show proof of our identity.
                 X

Applicant Signature

Date

(cid:41)
(cid:41)

        X

Other Applicant Signature

Date

ANNUAL PERCENTAGE RATE
For Purchases

ANNUAL PERCENTAGE RATE
For Balance Transfers

ANNUAL PERCENTAGE RATE
For Cash Advances

How To Avoid Paying Interest
on Payments

For Credit Card Tips From The Federal
Reserve Board

CREDIT CARD REQUEST

9.9%           to             10.9%
When you open your account based on creditworthiness
9.9%           to             10.9%
When you open your account based on creditworthiness
9.9%           to             10.9%
When you open your account based on creditworthiness
Your due date is at least 25 days after the close of each billing cycle. We will
not charge you interest on purchases if you pay your entire balance by the
due date each month.
To learn more about factors to consider when applying for or using a credit
card, visit the website of the Federal Reserve Board at:
 http://www.federalreserve.gov/creditcard.

Set-up And Maintenance Fees

Annual Fees
Lost Card Replacement

Transaction Fees
Penalty Fees

Late Payment

None
$10.00

None

$20.00

How We Will Calculate Your Balance:  We use a method called “Average Daily Balance (including new purchases)”. See

             your account agreement for more details.
Billing Rights: Information on your rights to dispute transactions and how to exercise those rights is provided in your

             Account agreement.

I/we request that a credit card(s) be issued on my/our account and agree that I/we will be bound by the terms and conditions of the card as defined in the Credit Card Agreement accompanying the credit card(s)
and all the amendments when I/we use the card(s).

(cid:41)

       X
Signature of Applicant/Borrower

(cid:41)

      X
    Signature of Spouse/Co-applicant (if applicable)

Date

Date

READ THIS FORM—COMPLETE ENTIRELY—SIGN BY ALL THE X’s ON ABOVE—RETURN TO CREDIT UNION

© ConmarSystems, Inc., Peachtree City, GA 30269—CFS 13495  Rev. 2/10  ORDER DATE:

TotaLoanTM

TO BE REPRODUCED ONLY
BY PERMISSION OF
CONMAR SYSTEMS, INC.

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