Diversified Credit Union
700 Linden Ave. W.  Minneapolis, MN 55403
Phone: 1-800-333-7757
Fax: 612-321-5297

LOAN APPLICATION

Important Notice about Procedures for Opening a New Account:
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.


TYPE AND AMOUNT OF CREDIT YOU'RE REQUESTING

Is this your first loan from us? yes  no
Amount/Credit Limit Requested: $
Approximate Time to Repay: Months
Loan Type:
APPLICANT INFORMATION

If you live in a community property state, are you:
  Married  Separated  Unmarried (Single/Divorced/Widowed)

Complete Co-Applicant information only if any of the following apply:
  1. This is for joint credit with Your Spouse or other Co-Applicant
  2. Your Spouse will use Your Account
  3. You're relying on Your Spouse's income as a source of repayment for the credit requested
  4. You live in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI or Puerto Rico)

Married applicants can apply for individual credit. Indicate if You would like:
Individual Credit     Joint Credit with Your Spouse   
Joint Credit with a Guarantor or another Applicant

Method of Payment:   
Payroll Deduction  Auto-Share Transfer  Cash Payment

Frequency of Payment:
Bi-Weekly   Semi-Monthly   Monthly

APPLICANT

Name:   

CU Account #: (if applicable)       Social Security #: 

Birth Date: (applicants must be 18 years of age or older)

Driver's License #:  State:

Address:  City: State:   Zip:

Home Phone:   Business Phone:   Email Address:

      DEBTS

Mortgage/Rent owed to:

Balance (Mortgage only):

$     Monthly Payment: $

     INCOME

Employer:

Job Title:

     Gross Monthly Income: $  

Other Income:

Source:   $ Annual Monthly
(You need not list income from alimony, child support or separate maintenance payments unless you want it considered in evaluating this application.)
CO-APPLICANT

Name:   

CU Account #:      Social Security #:

Birth Date: (applicants under the age of 21 need an adult co-signer)

Driver's License #:  State:

Address:   City: State:   Zip:

Home Phone:       Business Phone:

     DEBTS

Mortgage/Rent owed to:

Balance (Mortgage only):

$   Monthly Payment: $

     INCOME

Employer:

Job Title

     Gross Monthly Income:  $

Other Income:

Source:   $ Annual Monthly
(You need not list income from alimony, child support or separate maintenance payments unless you want it considered in evaluating this application.)

COMMENTS

PAYMENT PROTECTION COVERAGE Check if desired
 I would like a credit union loan representative to tell me more about Payment Protection Insurance options protecting me and my family in the event of disability or death.


You warrant the truth of the above information and You realize that it will be relied upon by Us in deciding whether or not to grant the credit applied for. You hereby authorize Us, Our employees and agents to investigate and verify any information provided to Us by You. If this application is for any Feature Category contained in Our Credit Line Account Program, You agree and understand that if approved, You are contractually liable according to the applicable terms of the Credit Line Account Agreement and Disclosure. You will receive a copy of that Agreement no later than the time of Your first credit advance and You promise to pay all amounts charged to Your Account according to its terms. If this is a joint application, You agree that such liability is joint and several. You authorize Us to accept Your facsimile signatures on this application and agree that Your facsimile signature will have the same legal force as Your original signature. You assume any risk that may be associated with permitting Us to accept Your facsimile signature.

Tab past this field:


 

X________________________________
Applicant Signature and Date (if printed form)

X________________________________
Co-Applicant Signature and Date (if printed form)

Both signatures required for joint application.

For Electronic Applications: Please press the Submit button on this page when ready.
For Printed Applications:
Press the Print button in your web browser's menu bar when ready. Sign the printed form and fax to 612-321-4401 or mail to Diversified Credit Union, 700 Linden Ave. W, Minneapolis, MN 55403.


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