Your savings federally
insured to at least $250,000
and backed by the full faith
and credit of the United States Government.

KUMC Credit Union
Secure Loan Request

KUMC Credit Union Loan Request

Please Enter your Email Address:

Married applicants: If you are requesting individual or or joint credit, you must complete the Applicant section about yourself and the Co-Applicant section about your spouse.

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Type of Loan Applied For:
Personal (Signature)-- Share Secured -- Overdraft Protection New Auto
Used Auto Other:

Amount applied for: $
Purpose:
Desired Length of Repayment (mon):

Method of Payment:
Payroll Deduction ACH Origination - Automatic Transfer from: - Savings -- Checking

Payment Protection Plan:
Would you like to purchase Credit Life Insurance?
Single Credit Life (only available for Applicant)
Joint Credit Life
None

Would you like to purchase Credit Disability Insurance?
Single Credit Disability (only available for Applicant)
None

Would you like to purchase GAP insurance?
Yes
No

Would you like to purchase an Extended Warranty?
Yes
No

Are you a U.S. Citizen?
Yes -- No

Have you ever had a judgment, bankruptcy, repossesion, or lawsuit?
Yes -- No

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Applicant:
Name:
Account #:
Social Security #:
Birthdate (MM/DD/YY):
Home Phone #:
Cell Phone #:
Present Address:
Street:
City:
State & Zip:
Current Address since: (MM/YY):
If less than 3 yrs enter previous address:

Joint Applicant:
Name:
Account #:
Social Security #:
Birthdate (MM/DD/YY):
Home Phone #:
Cell Phone #:
Present Address:
Street:
City:
State & Zip:
Current Address since: (MM/YY):
If less than 3 yrs enter previous address:

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Employment and Income: In order to expedite the processing of your loan application please fax your paystub copies to (913) 588-5383, Attention: Loan Department. If self-employed or retired, financial statement or income tax returns will be needed.

Applicant:
Employer Name:
Employer Phone #:
Employer Address:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income: $
Other Income: $ per Month

Joint Applicant:
Employer Name:
Employer Phone #:
Employer Address:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income: $
Other Income: $ per Month

NOTE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for this credit request.

Applicant:
Complete if current is less than 2 years:
Previous Employers Name:
Years Employed:

Joint Applicant:
Complete if current is less than 2 years:
Previous Employers Name:
Years Employed:

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Reference Information :
Reference Name:
Reference Address:
Reference Phone:
Reference Cell Phone:

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Credit Information : Please list all open Accounts with a balance.

Applicant: CREDITOR:	MONTHLY PAYMENT:	Joint Applicant: CREDITOR:	MONTHLY PAYMENT:
Housing Rent Own None		Housing Rent Own None

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You agree that everything stated in this application is correct to the best of your knowledge. The Credit Union is authorized to investigate your creditworthiness, employment history, and to obtain a credit report and to answer questions about their credit experience with you. You understand that any false or misleading statement in your application may cause any loan or extension of credit to be in default. You authorize us to accept your facsimile signatures on this application and agree that your facsimile signature will have the same legal force and effect as your original signature. You assume any risk that may be associated with permitting us to accept your facsimile signature.

By pressing the "Send Application" button below, you agree to the above statement. You understand that we may require your signature on additional documents prior to disbursing any credit proceeds.

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KUMC Credit Union Secure Loan Request

KUMC Credit Union
Secure Loan Request