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Mastercard Application

Fields marked * are required

Email Address*

APPLICANT

Credit Union Account Number

First Name* Middle Initial Last Name*.

DOB* SSN* Drivers License Number*

Mother's Maiden Name*

Provide your marital status only if this loan request is for secured credit or if you reside in one of the following community property states: AZ, CA, ID, LA, NM, NV, TX, WA, WI. If neither of the preceding conditions apply, select No Answer to Marital Status.

Marital Status No. of Dependants Ages

Daytime Phone Number* Evening Phone Number

Work Phone Number Cell Phone Number*

Address:* City State ZIP

Rent/Own: Monthly Payment

Years at this address

Previous Address

Complete this section only if you have not been at your current address for more than 2 years.

Address City State ZIP

Years at this address

Because you live in a community property state, include your spouse.

Employment

Your Work Title:

Name of Employer: Supervisor Name:

Address City State ZIP

Years At This Job* Gross Monthly Salary *

Pay Frequency *

Previous Employment

Complete this section only if you have worked less than 2 years at your current employer. Click "Add Previous Employment" to enter additional previous employment information.

Name of Employer:

Address City State ZIP

Years At This Job*

Other Income

Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.

Other Income - Source: Other Income - Amount:

Other Gross Income - Frequency:

Outstanding Debt

Provide your outstanding debt information below.

Creditor 1: Current Balance : Monthly Pmt :

Creditor 2: Current Balance : Monthly Pmt :

Creditor 3: Current Balance : Monthly Pmt :

Creditor 4: Current Balance : Monthly Pmt :

References

Provide two references. Please do not use relatives living at your address.

Reference Name: Relationship to Member :

Address City State ZIP

Reference Day Phone

Reference Name2: Relationship to Member :

Address City State ZIP

Reference2 Day Phone

CO-APPLICANT


Credit Union Account Number

Relationship to Applicant

First Name Middle Initial Last Name.

DOB SSN Drivers License Number

Daytime Phone Number Evening Phone Number

Work Phone Number Cell Phone Number

Address City State ZIP

Year at this address

Previous Address

Complete this section only if you have not been at your current address for more than 2 years.

Address City State ZIP

Years at this address

Because you live in a community property state, include your spouse.

Employment

Your Work Title:

Name of Employer: Supervisor Name:

Address City State ZIP

Years At This Job* Gross Monthly Salary *

Pay Frequency *

Previous Employment

Complete this section only if you have worked less than 2 years at your current employer. Click "Add Previous Employment" to enter additional previous employment information.

Name of Employer:

Address City State ZIP

Years At This Job*

Other Income

Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.

Other Income - Source: Other Income - Amount:

Other Gross Income - Frequency:

 

Outstanding Debt

Provide your outstanding debt information below.

Creditor 1: Current Balance : Monthly Pmt :

Creditor 2: Current Balance : Monthly Pmt :

Creditor 3: Current Balance : Monthly Pmt :

Creditor 4: Current Balance : Monthly Pmt :

References

Provide two references. Please do not use relatives living at your address.

Reference Name:* Relationship to Member :

Address* City* State* ZIP*

Reference Day Phone*

Reference Name2:* Relationship to Member :

Address* City* State* ZIP*

Reference2 Day Phone*


 

 

REVIEW YOUR APPLICATION.

Review all of your answers carefully.It is a federal crime to willfully and deliberately provide incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. 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.

By submitting this application, 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.

Initial the box below to acknowledge that you have read and agree to the Telco Plus Credit Union MasterCard Terms and Conditions.