Type of Account:* Individual    Joint
Amount Requested:* $
Purpose/Collateral:*

Repayment:*  Payroll Deduction    Cash    Military Allotment    Automatic Payment
Payment Protection:* None    Single Credit Disability Insurance    Single Credit Life Insurance    Joint Credit Life Insurance   

Applicant

Name (Last - First - MI):*    Account Number:    SSN (xxx-xx-xxxx):*

Driver's License Number:*    DL State:*    List Ages of Dependents:

Birth Date:*  
Home Phone:*    Business Phone:
Email Address:    Marital Status: Single    Married    Separated
Present Address:*    City:*    State:*    Zip:*
Ownership:* Own    Rent
Years at this Address:*

Previous Address:    City:    State:    Zip:
Ownership: Own    Rent
Years at this Address:
Are you a U.S. citizen or permanent resident alien? Yes    No
Do you currently have any outstanding judgments or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit? Yes    No
Is your income likely to decline in the next two years? Yes    No
Are you a co-maker, co-signer or guarantor on any loan not listed above? Yes    No

Employment/Income

Name of Employer:*    Supervisor:*    Start Date:*

Address:*    City:*    State:*    Zip:*
Job Title:*    Hours at Work:*
If Self-Employed, Type of Business:
Income:* $ Per:
Income Type: Gross    Net
Other Income: $ Per:    Source:

Previous Employer:    Start Date:    End Date:
Address:    City:    State:    Zip:

Military: is duty station transfer expected during next year? Yes    No
Where:    Ending Date:

Reference

Name of nearest relative not living with you:    Relationship:    Phone:
Address:    City:    State:    Zip:

What You Owe

Rent/1st Mortgage — Owned By: Applicant    Co-Applicant
Creditor Name:    Interest Rate: %   Balance: $   Monthly Payment: $
2nd Mortgage — Owned By: Applicant    Co-Applicant
Creditor Name:    Interest Rate: %   Balance: $    Monthly Payment: $
1st Auto Loan — Owned By: Applicant    Co-Applicant
Creditor Name:    Interest Rate: %   Balance: $    Monthly Payment: $
2nd Auto Loan — Owned By: Applicant    Co-Applicant
Creditor Name:    Interest Rate: %   Balance: $    Monthly Payment: $
Child Care — Owned By: Applicant    Co-Applicant
Creditor Name:    Interest Rate: %   Balance: $    Monthly Payment: $
Child Support — Owned By: Applicant    Co-Applicant
Creditor Name:    Interest Rate: %   Balance: $    Monthly Payment: $
Credit Card — Owned By: Applicant    Co-Applicant
Creditor Name:    Interest Rate: %   Balance: $    Monthly Payment: $
Credit Card — Owned By: Applicant    Co-Applicant
Creditor Name:    Interest Rate: %   Balance: $    Monthly Payment: $
Other — Owned By: Applicant    Co-Applicant
Creditor Name:    Interest Rate: %   Balance: $    Monthly Payment: $
Other — Owned By: Applicant    Co-Applicant
Creditor Name:    Interest Rate: %   Balance: $    Monthly Payment: $

What You Own

Home — Owned By: Applicant    Co-Applicant   Pledged as collateral for another loan: Yes    No
Location of Property or Financial Institution:    Market Value: $
Auto — Owned By: Applicant    Co-Applicant   Pledged as collateral for another loan: Yes    No
Location of Property or Financial Institution:    Market Value: $
Savings — Owned By: Applicant    Co-Applicant   Pledged as collateral for another loan: Yes    No
Location of Property or Financial Institution:    Market Value: $
Checking — Owned By: Applicant    Co-Applicant   Pledged as collateral for another loan: Yes    No
Location of Property or Financial Institution:    Market Value: $
Other — Owned By: Applicant    Co-Applicant   Pledged as collateral for another loan: Yes    No
Location of Property or Financial Institution:    Market Value: $

Signatures

Applicant Approval: I promise that everything I have stated in this application is correct to the best of my knowledge and that the above information is a complete listing of what I owe, if there are any important changes I will notify HOTFCU in writing immediately. I authorize the credit union to obtain credit reports in connection with this application for credit and for any updates, renewal of the credit received. I understand that the credit union will rely on the information in this application and my credit report to make its decision. Please type in your full name.*  

How did you hear about Heart of Texas Federal Credit Union?*  
(Example: Referral, Website/Online Search, Newspaper/Magazine Ad, Phone Book, Billboard, etc.)
Loan office to submit to: