H.C.T.A FEDERAL CREDIT UNION 3454 Ellicott Center Drive Ellicott City, Maryland 21043 (410) 461-2257 www.hctafcu.org FAX (410) 461-4691 info@hctafcu.org

MASTER APPLICATION MUST BE COMPLETED IN INK Notice to Married Applicants: You have the right To apply for a separate account in your name.

please read and initial

There is a $10.00 fee per year for a Credit Check

Share Balance $

Loan Balance

Loan Balance

Account Number

I/We would like a loan of: $

Term of Loan

Method of payment __ Bi-weekly __ Monthly

Purpose of Loan

a. applicants personal information

Check one if you reside in or are relying on property in a community property state or if you are applying for other than individual unsecured credit. __ Married __ Unmarried __ separated

name (last, first, initials)

Date of birth

Social Security Number

present street address (street, city, state, zip)

how long? ___ yrs ___mos

home phone number

Previous street adress (if present address less than two years)

how long? ___ yrs ___mos

Number of dependents

B. information regarding applicant

present employer

employer’s address (street, city, state, zip)

date employed

occupation

work phone & ext.

my pay period is over __ 12 months __ 10 months

gross bi-weekly income(attach copy of pay stub) $

other income notice: Do not list alimony, child or spousal support or separate maintenance payments unless you wish them considered as a basis for repayment of the credit requested. If listed, verification may be requested.

Source of other income

total monthly income $

c. information regarding spouse or co-applicant

Please read before completing: complete this section: 1. if you are relying on your co-applicant’s income as a basis for repayment of the credit requested, or 2. If your co-applicant will be contractually liable on the loan, or 3. If you are relying on alimony, child support or separate maintenance payments form a spouse or former spouse as a basis for repayment of the credit requested. ___ spouse ___ co-applicant

name (last, first, initial)

social security no.

date of birth

street address (street, city, state, zip)

occupation

work phone and ext.

present employer name and address (street, city, state, zip)

date employed

other income notice: Do not list alimony, child or spousal support or separate maintenance payments unless you wish them considered as a basis for repayment of the credit requested. If listed, verification may be requested.

source of other income:

Total monthly income (attach copy of pay stub) $

applicant

d. list all existing debts of applicant (and co-applicant or spouse if any part of section c is applicable)

co-appl.

name & address of creditor

purpose or acct #

original amount

present balance

monthly payment

home mortgage or landlord

__ renting __ buying

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

List alimony, child support or child care paid monthly

$

Do not omit any debts. if more space is needed, plese use separate sheet. incomplete applications cannot be processed.

total montly obligations $

if you answer yes to any of these questions, provide details on page 2.

are any of your debts past due? __yes __no

have you ever had your auto, furniture or property repossessed? __ yes __ no

have you or your co-applicant ever declared bankruptcy? __ yes __ no

are you currently a co-maker on a loan? __ yes __ no

continue application on reverse side – sign the reverse side of the application before submitting

e. financial information and references
name of bank or other financial institution							type of accounts __ checking __ savings __ loans
name of relative not living with you	name (last, first, initial) present address (street, city, state, zip)						phone no.	relationship
personal reference not related to applicant			name (last, first, initial) present address (street, city, state, zip)					phone no.
f. vehicle information
name(s) (to appear on title) address city state zip
seller’s name seller’s address city state zip
description:		year		make	model	serial number			__ new __ used
the credit union requires that you carry at least $100.00 deductible plus comprehensive insurance for the duration of the loan.
insurance company				address city state zip
agent’s name						agent’s phone number
G. insurance iformation
I am interested in applying for the insurance coverage(s) checked below. I understand that the cost will be disclosed on my Truth-in-Lending Disclosure Statement. I understand that this is not an application for insurance. This insurance is voluntary and is not a condition for approval of my loan or credit plan. Insurance coverage will become effective after I apply and meet the eligibility requirements of the group policies, when my loan is approved. To be eligible for Group Credit Life and Disability Insurance: · You and your co-applicant must be under age 70 or Credit Life insurance or under age 66 for Credit Disability insurance on the schedule maturity date of your loan to apply for these coverages. · You must be presently working outside the home for wages or profit for 30 hours or more per week for the past 30 days or more to apply for Credit Disability Insurance. · If you are applying for more than $15,000 of insurance the following must be true: During the last two years, you and your co-applicant have NOT been medically advised of or treated for: cancer, heart attack or coronary artery disease, stroke cirrhosis, Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC).
__ single credit life __ joint credit life __ credit disability
I have read and understand the eligibility requirements of the insurance coverages above and would like to apply for the coverages checked: _____ Initial Here
loan application signatures
please read before signing: All the information in this application is true. I understand that section 1014 Title 18 U.S. Code make it a federal crime to knowingly make a false statement on this application. You have my permission to check it. You may retain this application even if not approved. I understand that you may receive information from others about my credit and you may answer questions and requests from others seeking credit or experience information about me or my accounts with you. If this application is approved I agree to honor the provisions of the credit or loan agreement and security agreement covering my account or loan. (If this application is for two of us, this statement applies to both of us.
signature of applicant date X					signature of co-applicant date X
have you omitted anything? remember: incomplete applicationws cannot be processed.
additional comments
for credit union use only
loan officer: __ approved __ rejected __ referred to credit committee
reason
loan officer’s signature: date X
credit committee: __ approved __ rejected
reason
credit committee’s signatures date X				date X		date X
ecoa notice sent or delivered on					by
page 2 of 2