Shell Geismar Federal Credit Union

Loan Application

Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:

1. You live in or the property pledged as collateral is located in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI)
2. Your spouse will use the account, or
3. You are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about the person on whose payments you are relying.

Joint Credit: If you are applying with another person, complete the Applicant and Other sections.

Guarantor: Complete the Other section if you are a guarantor on an account/loan.

Loan Information

Account / Loan (required)

Individual

Joint

Amount Requested $

Purpose of Loan

Personal Information

First Name (required)

Last Name (required)

Mothers Maiden Name (required)

Social Security # (required)

Account # (required)

Driver's License Number / State (required)

Email address (required)

Date of Birth (required)

Martial Status (required)

Married

Separated

Single

Phone Number

Home Phone (required)

Cell Phone

Work Phone

Address

Current Address

City (required)

State (required)

Zip (required)

Status (required)

Own

Rent

Years at this Address (required)

Financial Information

Mortgage / Rent owed to (required)

Mortgage Balance

Monthly Payment

Interest Rate

Employer Name (required)

Employer Address (required)

Monthly Income (required)

Other income source

Other Income per month

Co-applicant

First Name

Last Name

Mothers Maiden Name

Social Security #

Account #

Driver's License Number / State

Email address

Date of Birth

Martial Status

Married

Seperated

Single

Home Phone

Cell Phone

Work Phone

Current Address

City

State

Zip

Status

Rent

Own

Years at this address

Co-Applicant Financial Info

Mortgage / Rent Owed to

Mortgage Balance

Monthly Payment

Interest Rate

Employer Name

Employer Address

Monthly Income

Other Income Source

Other Income Per Month

Disclosure

State Law Notices

OHIO RESIDENTS ONLY: The Ohio laws discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administrators compliance with this law.

WISCONSIN RESIDENTS ONLY:(1)No provision of any marital properly agreement unilateral statement under Section 766.59, or court degree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is Furnished a copy of the agreement, statement or degree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2)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.

Signature(s)

You agree that everything you have stated in this application is correct to the best of your knowledge. 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 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. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.

Applicant Signature (required)

Co-Applicant Signature

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