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| *First Name |
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| Middle Name |
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| *Last Name |
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| *SSN |
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| *Birthdate (MM/DD/YYYY) |
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| *Daytime Phone |
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| *Email |
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| *Marital Status |
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| *Mother's Maiden Name |
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| Current Address (You must have a physical address. No P.O. Boxes.) |
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| *Address |
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| *City |
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| *State |
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| *ZIP |
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| *Length of time at this address |
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| County of Residence |
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| *Do you own or rent your current home? |
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| If Other, please explain: |
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| *Monthly Mortgage/Rent Payment |
$
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| Employment & Income Information |
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| *Current Employer |
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| *Annual Earnings |
$
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| *Length of Employment |
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| *Employer Phone |
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| Do you have any other sources of income? If so, please explain: |
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| Please list any other assets you own, including any vehicles or real estate, along with the value. If “None,” you may leave this space blank: |
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| *Do you currently pay monthly alimony or child support? |
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| If Yes, how much? |
$
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| *Are you applying with a Co-Applicant? |
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| Co-Applicant Information (If you are not applying with a co-applicant, click here to skip to the next section of this form. Fields marked with a + are required if you are applying with a co-applicant.) |
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| +First Name |
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| Middle Name |
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| +Last Name |
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| +SSN |
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| +Birthdate (MM/DD/YYYY) |
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| +Daytime Phone |
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| Email |
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| +Marital Status |
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| +Mother’s Maiden Name |
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| +Address |
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| +City |
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| +State |
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| +ZIP |
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| +Length of time at this address |
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| +Do you own or rent your current home? |
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| If Other, please explain: |
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| +Monthly Mortgage/Rent Payment |
$
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| +Current Employer |
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| +Annual Earnings |
$
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| +Length of Employment |
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| +Employer Phone |
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| Do you have any other sources of income? If so, please explain: |
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| Please list any other assets you own, including any vehicles or real estate, along with the value. If “None,” you may leave this space blank: |
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| +Do you currently pay monthly alimony or child support? |
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| If Yes, how much? |
$
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*What type of loan are you applying for? |
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| If Other, please explain: |
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| *Desired Loan Amount |
$
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| *Desired Loan Repayment Term |
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| *Payment Schedule |
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| *Will you be making a down payment? |
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| If Yes, how much? |
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| Vehicle Information (If you do not yet know what vehicle you are purchasing, enter TBD (to be determined) in the spaces below.) |
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| *Condition |
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| *Year |
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| *Make & Model |
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| *Mileage |
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| Additional options or information about the vehicle: |
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| Tell us a little more about your loan. Is there anything else we should know, in order to process your application? |
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| Are you interested in purchasing additional insurance on this loan? If so, please check the boxes for the insurance products you would like: |
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Notice to Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equality to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.
I (We) certify that the above information is true and complete. I (We) also authorize the credit union to verify or obtain further information that the credit union may deem necessary concerning my (our) credit standing. If an account is opened, I (we) authorize you to report our credit experience with me (us). The undersigned jointly and severally agree to be responsible for all charges. I (We) hereby authorize Miami University Community Federal Credit Union to act on my (our) behalf to transfer the balance(s) listed above to my new Miami University Community Federal Credit Union credit card. Miami University Community Federal Credit Union reserves the right to transfer only the current credit card balance(s).
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