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Loan Application

Please provide all the requested information. When you have completed the form, press the "Submit" button to send your application. You'll hear back from us the same day during our normal business hours for all loan applications except Mortgages. We will respond within 48 business hours for Mortgage applications.

* INDICATES REQUIRED FIELDS

Is this an individual or joint loan? IndividualJoint
Type of Loan Requested:
Term of Loan Desired:
Amount Requested:
Reason for loan:
Referred By:
Additional Comments:


 Primary Borrower Information
First Name:*
Middle Initial:*
Last Name:*
Date of Birth:*
Social Security No.:*
Member Number:*(enter 00000 if you do not have a number)
Number of Dependents:*
Email:*
Send me email updates about Premier’s latest offers:*
Preferred Contact Branch:
Current Address:*
City, State, Zip Code:*
Current Phone Number:*
Current Employer:*
Current Work Phone:*
Current Job Title:*
Start Date:*
Gross Annual Income:*
Additional Income:
Source:

DEMOGRAPHIC INFORMATION OF BORROWER

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, federal law requires that we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application.

 

Instructions: You may select one or more “Hispanic or Latino” origins and one or more designations of “Race.” If you do not wish to provide some or all of this information, select the applicable check box.

Ethnicity: Hispanic or Latino
Mexican
Puerto Rican
Cuban
Not Hispanic or Latino
I do not wish to furnish this information
Other Hispanic or Latino
If "Other", Enter Origin:
Examples: Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.
Race: American Indian or Alaskan Native
Asian
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Black or African American
Native Hawaiian
Guamanian or Chamorro
Samoan
White
I do not wish to furnish this information
Other Asian
Other Pacific Islander
If "American Indian or Alaskan Native", Enter name of enrolled or principal tribe:
If "Other", Enter Race:
Examples: Hmong, Laotian, Thai, Pakistani, Cambodian, Fijian, Tongan, etc.
Sex: Male
Female
I do not wish to furnish this information
Nearest Relative NOT living with you
First Name:
Last Name:
Address:
City, State, Zip Code:
Home Phone:


 Co-Borrower Information
The Co-Borrower listed below acknowledges his or her intent to apply for joint credit.*
First Name:*
Middle Initial:*
Last Name:*
Date of Birth:*
Social Security No.:*
Number of Dependents:*
Email:
Current Address:*
City, State, Zip Code:*
Current Home Phone:*
Current Employer:*
Current Work Phone:*
Current Job Title:*
Start Date:*
Gross Annual Income:*
Additional Income:
Source:

DEMOGRAPHIC INFORMATION OF CO-BORROWER

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, federal law requires that we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application.

 

Instructions: You may select one or more “Hispanic or Latino” origins and one or more designations of “Race.” If you do not wish to provide some or all of this information, select the applicable check box.

Ethnicity: Hispanic or Latino
Mexican
Puerto Rican
Cuban
Not Hispanic or Latino
I do not wish to furnish this information
Other Hispanic or Latino
If "Other", Enter Origin:
Examples: Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.
Race: American Indian or Alaskan Native
Asian
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Black or African American
Native Hawaiian
Guamanian or Chamorro
Samoan
White
I do not wish to furnish this information
Other Asian
Other Pacific Islander
If "American Indian or Alaskan Native", Enter name of enrolled or principal tribe:
If "Other", Enter Race:
Examples: Hmong, Laotian, Thai, Pakistani, Cambodian, Fijian, Tongan, etc.
Sex: Male
Female
I do not wish to furnish this information


Debts: Monthly Payments:

In addition to Rent/Mortgage, list all other debts (for example auto loans, credit cards, second mortgage, alimony, child support, child care, medical, utilities, auto insurance, IRS liabilities, etc.). Please use a separate line for each credit card and auto loan. Income verification is required; therefore, other information may be necessary.
** Alimony or child support maintenance payments are optional information and need not be revealed if the applicant does not choose to rely on such income in applying for credit. I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of Premier Credit Union, any information concerning my affairs or me. Sec. 1014, Title 13, U.S. Code, makes it a Federal Crime to knowingly make a false statement on this application.
The above information is accurate and posted on this site on 09/15/04. Please call the credit union at (515) 282-1611/toll-free (866) 273-9938 for any changes.

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