IMPORTANT INFORMATION ABOUT PROCEDURES FOR APPLYING FOR A LOAN

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 or business that opens an account. 
What this means for you: When you open an account, we will ask for your name, address, date of birth, if applicable, and other information that will allow us to
identify you. 
We may also ask to see your driver's license or other identifying documents.
Married Applicants may apply for a separate account.

Business - Expanded Application

Member/Account Number:
Application Type:
Type of Application:

New

Renewal/Change

Other:

Individual/Business

Joint (Co-Applicant must individually complete Co-Applicant Information)

LOAN REQUEST

Amount requested: $
Type:

Line of Credit
Commercial Real Estate

Terms/Maturity:
Term Loan
Other:

Purpose of Loan:

Credit Card

LOAN SECURITY

Liens/Security Interest and State Filed:

Collateral Description:
Value:
Subject Property Address (street, city, state, and zip):
Collateral Owner (if not borrower):
Legal Description of Subject Property:
Number of Units:
Life Insurance Policy #:
Insurance Agent:

Year Built:

Assessed Value:
Coverage Amount:
Telephone Number:

BUSINESS/INDIVIDUAL NAME

YEAR BUSINESS ESTABLISHED

STATE

APPLICANT/INDIVIDUAL INFORMATION

BUSINESS LICENSE NUMBER

ISSUANCE DATE

EXPIRATION DATE

STATE ISSUED

NATURE OF BUSINESS

DBA NAME(S)

PRIOR BUSINESS NAME(S)

CONTACT NAME

TYPE OF ORGANIZATION:

OTHER STATES OPERATING IN

TITLE

TELEPHONE

INDIVIDUAL

PROPRIETORSHIP

PARTNERSHIP

CORPORATION

LLC

ASSOCIATION

NON-PROFIT

OTHER:

IF INDIVIDUAL, PROVIDE THE FOLLOWING INFORMATION:
EMPLOYER NAME

EMPLOYER TELEPHONE NUMBER

EMPLOYER ADDRESS

TITLE/GRADE

START DATE

SSN/TIN/EIN NUMBER

DRIVER'S LICENSE NUMBER/STATE

ISSUANCE DATE

EXPIRATION DATE

DATE OF BIRTH

HOME TELEPHONE

WORK TELEPHONE

CELL PHONE

FAX NUMBER

WEB SITE ADDRESS/EMAIL

PHYSICAL ADDRESS

MAILING ADDRESS

COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:

ID VERIFICATION:

MARRIED

SEPARATED

UNMARRIED (Single - Divorced - Widowed)

OWN

LEASE

OTHER

TELEPHONE NUMBER

CONTACT NAME

TITLE

NUMBER  
OF YEARS

OWNERSHIP 
PERCENTAGE

SSN/TIN 
NUMBER

FRANCHISE INFORMATION

NAME

ADDRESS

OWNERSHIP/COMPANY OFFICER INFORMATION:

NAME

CHECK IF ADDITIONAL OWNERSHIP INFORMATION ACCOMPANIES THIS APPLICATION.

CUNA Mutual Group 2004, 06 All Rights Reserved

AXB203-e

1. I AM PROVIDING THE FOLLOWING INFORMATION FOR PURPOSES OF SERVING AS A (CHECK ONE):

SSN/TIN NUMBER

DATE OF BIRTH

GUARANTOR/CO-APPLICANT

GUARANTOR

CO-APPLICANT

NAME

DRIVER'S LICENSE NUMBER/STATE

ISSUANCE DATE

EXPIRATION DATE

HOME TELEPHONE

WORK TELEPHONE

CELL PHONE

FAX NUMBER

WEB SITE ADDRESS/EMAIL

PHYSICAL ADDRESS

MAILING ADDRESS

GUARANTOR/CO-MAKER ON OTHER LOANS (Lender name, term, and amount)

COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:

ID VERIFICATION:

MARRIED

SEPARATED

UNMARRIED (Single - Divorced - Widowed)

2. I AM PROVIDING THE FOLLOWING INFORMATION FOR PURPOSES OF SERVING AS A (CHECK ONE):

SSN/TIN NUMBER

DATE OF BIRTH

GUARANTOR

CO-APPLICANT

NAME

DRIVER'S LICENSE NUMBER/STATE

ISSUANCE DATE

EXPIRATION DATE

HOME TELEPHONE

WORK TELEPHONE

CELL PHONE

FAX NUMBER

WEB SITE ADDRESS/EMAIL

PHYSICAL ADDRESS

MAILING ADDRESS

GUARANTOR/CO-MAKER ON OTHER LOANS (Lender name, term, and amount)

COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:

ID VERIFICATION:

MARRIED

SEPARATED

UNMARRIED (Single - Divorced - Widowed)

or

CHECK IF ADDITIONAL GUARANTOR/CO-APPLICANT INFORMATION ACCOMPANIES THIS APPLICATION.

SOURCES OF INCOME

Important Notice to Individuals 

ALIMONY-CHILD SUPPORT: The inclusion of alimony, separate maintenance, or child support as income is voluntary and need not be revealed if you do not 
wish to have it considered in evaluating this application.

GROSS ANNUAL INCOME

APPLICANT

GUARANTOR OR 
CO-APPLICANT #1

GUARANTOR OR 
CO-APPLICANT #2

TOTAL

SPOUSE 
(IF APPLICABLE)

NET SALES
BASE SALARY
OVERTIME
BONUS AND/OR COMMISSIONS
DIVIDENDS/INTEREST
NET RENTAL INCOME
ITEMIZED OTHER:
1.
2.
3.
4.
5.
TOTAL ANNUAL INCOME

LENDER

PURPOSE

CURRENT 
BALANCE

MONTHLY 
PAYMENT

HOW 
SECURED

CREDITOR INFORMATION

CHECK IF ADDITIONAL CREDITOR INFORMATION ACCOMPANIES THIS APPLICATION.

TOTALS

FINANCIAL INFORMATION

Please include copies of the following checked items as attachments to this application:

Federal Tax Return For:

Current Year
Borrower

Other:
Guarantor/Co-Applicant(s)

Accountant Name:
Address:

Balance Sheet for Current Year for:
Income Statement for Current Year:
Other:
Business Plan
Franchise Agreement (if applicable)

Borrower
Borrower
Borrower

Guarantor/Co-Applicant(s)
Guarantor/Co-Applicant(s)
Guarantor/Co-Applicant(s)

Telephone:

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Financial Services Accounts Information:

Checking

Checking

FINANCIAL INFORMATION (continued)

Borrower

Guarantor/Co-Applicant(s) ____ Number Attached

Borrower

Guarantor/Co-Applicant(s) ____ Number Attached

Savings

Savings

Borrower

Guarantor/Co-Applicant(s) ____ Number Attached

Borrower

Guarantor/Co-Applicant(s) ____ Number Attached

Other:

Borrower

Guarantor/Co-Applicant(s) ____ Number Attached

Check if additional account information accompanies this application.

Policy #:

Coverage Amount:
Telephone Number:

Insurance Coverages (Property, Liability, etc.)
Coverage:
Insurance Agent:

Other information (explain or indicate none)

Active lawsuits or judgments:

Filed bankruptcy:

Tax obligations or claims:

Environmental Impact Assessment Report:

Attorney Name:

STATE LAW NOTICES

laws
OHIO  RESIDENTS  ONLY:  The  Ohio 
against  discrimination  require  that  all  creditors
make  credit  equally  available  to  all  creditworthy  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. 

Telephone Number:

WISCONSIN RESIDENTS ONLY:   Please sign if you are not applying for this
account or loan with your spouse. The credit being applied for, if granted, will
be incurred in the interest of the marriage or family of the undersigned.

X

SIGNATURE FOR WISCONSIN RESIDENTS ONLY

DATE

SIGNATURES

You promise that everything you have stated in this application is correct to the
best of your knowledge and that the above information is a complete listing of
what you  owe. If there  are any  important changes you  will  notify us  in writing
immediately.  You  authorize  the  Credit  Union  to  obtain  credit  reports  in
connection  with  this  application  for  credit  and  for  any  update,  increase,
renewal, extension or collection of the credit received. You understand that the
Credit Union will rely on the information in this application and your credit report
to  make 
that
accompanies this application is complete and correct and that it's incorporated
as part of this application. If you request, the Credit Union will tell you the name
and address of any credit bureau from which it received a credit report on you.
It  is  a  crime  to  willfully  and  deliberately  provide  incomplete  or  incorrect
information in this application. 

that  requested  documentation 

its  decision.  You  agree 

The person(s) signing the application is/are indeed authorized to act on behalf
of  the  borrower.  Borrower,  co-applicant(s),  and  guarantor(s),  as  appropriate
grants  to  the  credit  union  the  authority  to  use  reasonable  means  to  verify
information  by  requesting  credit  bureau  reports,  accessing
application 
information  about  borrower,  co-applicant(s),  and  guarantor(s),  as  appropriate
from  other  third  party  information  providers,  and  other  means  if  applicable.
Borrower  further  grants  to  credit  union  the  right  to  share  this  information  with
third  parties  as  reasonable  in  the  normal  course  of  doing  commercial  lending
including sharing this information with a third party for purposes of underwriting
the  loan.  Borrower  agrees  to  pay  any  fees  charged  by  the  credit  union  for
processing this application and other related expenses whether the application
is approved or denied. You promise that the credit you are applying for is for a
business purpose. By signing below or by using your card, you understand that
either  of 
those  actions  will  constitute  acknowledgment  of  receipt  and
agreement to the terms of the credit card agreement and disclosures.

XBy:

XBy:

BORROWER

CO-APPLICANT

GUARANTOR

DATE

BORROWER

CO-APPLICANT

GUARANTOR

DATE

TITLE:

XBy:

TITLE:

XBy:

BORROWER

CO-APPLICANT

GUARANTOR

DATE

BORROWER

CO-APPLICANT

GUARANTOR

DATE

TITLE:

TITLE:

FOR CREDIT UNION USE ONLY

VERIFICATION COMPLETION DATE

BY

GOVERNMENT LIST(S) CHECKED:

TREASURY CIP LIST

OFAC

OTHER:

LIST VERIFICATION COMPLETION DATE

BY

DATE

APPROVED

DENIED  
(Adverse Action Notice Sent)

APPROVED 
LIMITS:

LOAN OFFICER COMMENTS:

SIGNATURES:
X

SIGNATURE

LINE OF CREDIT

CREDIT CARD

OTHER

OTHER

$

$

X

$

$

$

DATE

DATE

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