Check below to indicate the type of account(s) and type of credit for which you are applying. Married Applicants may apply for a separate account.
Fields marked with * are compulsory
Amount Requested *
Purpose/Collateral *---New VehicleUsed VehicleNew MotorcycleUsed MotorcycleNew BoatUsed BoatNew RVUsed RVALL LoanLine of CreditSignature LoanVisa Credit Card
Repayment *---Payroll DeductionCashMilitary AllotmentAutomatic Payment
First Name *
Last Name *
Account Number *
Social Security Number *
Date of Birth *
Primary Phone *
Marital Status ---MarriedSeparatedUnmarriedDivorcedWidowed
Street Address *
Present Address Type---OwnRent
Present Address Time---Less than a year1 to 2 years3 to 5 years5 to 10 yearsMore than 10 years
Employer Name *
Employer Street Address
Hours at Work
Employment Gross Income *
Income Timeframe *---WeeklyBi-WeeklyMonthlyBi-MonthlyYearly
Other Gross Income *
Other Income Timeframe *---WeeklyBi-WeeklyMonthlyBi-MonthlyYearly
Military: Is Duty Station Transfer Expected During Next Year?---YesNo
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 the obligation.
Other Information About You
If You Answer "YES" to Any Question Other Than #1, Please send an attachment on this address: firstname.lastname@example.org
Are You A U.S Citizen or Permanent Resident Alien?---YesNo
Do You Currently Have any Outstanding Judgements or have you Ever Filed for Bankruptcy, Had a Debt Adjustment Plan Confirmed Under Chapter 13, Had Property Foreclosed Upon Or Repossessed in the last 7 Years, Or Been a Party in a Lawsuit?---YesNo
Is Your Income Likely to Decline in the next two years?---YesNo
Are You a Co-Maker, Co-Signer or Guarantor on Any Loan Not Listed Above?---YesNo
State Law Notices
(1) 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 (AK, 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.
Each Applicant must individually complete the appropriate section below. If Co-Borrower is spouse of the Applicant, mark the Co-Applicant box.
Complete the Other section if you are a guarantor on an account/loan.
OHIO RESIDENTS ONLY:
The Ohio laws against discrimination require that all creditors make credit equally available 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.
WISCONSIN RESIDENTS ONLY:
(1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree 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 decree, 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.
You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. 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.
I/We agree to the terms & conditions *
By selecting “I/We Agree to the Terms & Conditions”, providing the “Signature of Individual” and submitting the application, you are signing this Application electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Application. By selecting "Submit" using any device, means or action, you consent to the legally binding terms and conditions of this Application. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and the Delaware State Police Federal Credit Union.
Signature of Individual *