Home Equity Application - American 1 Credit Union

DISCLAIMER: I/We hereby certify that all statements made are true and complete, are submitted for the purpose of obtaining credit, and that the credit union may rely on them for such determination. We understand that federal law requires the verification of identification for all new accounts should I not have an existing account. I/We authorize you to obtain such information as you may require concerning the statements made in this application and proper identification, and agree that the application shall remain your property, and you are authorized to answer questions about your credit experience with me/us.

Co-Applicant Information

First Name:

Middle Name (If no middle name please enter None):

Last Name:

Street Address:

Street Address 2:

City:

State:

ZIP:

How long have you lived at this address?

Primary Phone Number:

Social Security Number:

- -

Birth Date:

/ /

E-Mail Address:

Current Employer Information (Co-applicant)

Current Employer:

What is Your Occupation:

Hire Date:

Work Phone Number:

Are you hourly?

Yes

If yes, what is your hourly rate?

How many hours/week do you work?

Are you salary:

Yes

If you are not hourly, what is your annual salary?

Please list all additional employers within last five years, including start and end date(s):

Please Note: Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Do you receive any other income such as social security, disability, or other payments?

Yes

Where is it from?

How much do you receive every month?

Co-Applicant Color Copy of Photo ID Front:

Co-Applicant Color Copy of Photo ID Back:

Pay Stub/Proof of Income:

AGREEMENT

State:

I accept:

I accept the terms of the disclaimer above and submit my application.