Lapeer County School Employees Credit Union
168 N. Saginaw St, PO Box 425, Lapeer, MI 48446
 APPLICATION FOR LOAN
Unsecured
Secured
Date Name Acct #

I/We hereby apply for a loan as follows: (to be completed by applicant)

$ Amount of money requested
$ Old Balance if any
$ Total new loan
To be repaid in months Monthly Payment of $
First payment date: (check one) 30 Days from date of loan Payroll Deduction
Purpose of loan

INDICATE THE TYPE OF CREDIT

Individual Credit (using applicant signature only)
 Joint Credit (using a comaker, guarantor or endorser) click here for co-maker application

SECURED INTEREST New/Used Auto -Secured Credit - Collateral

Make Model Year Cost/Value$
Owners Name Dealership Salesman
AccessoriesMileage

MARTIAL STATUS: (check one) Unmarried Married Separated
Full Name Birth Date Social Security Number
Address City State Zip Code
Home Phone Years there Drivers License #
Present Employer Business Phone Years there
Position/Title Supervisor
Employers Address City State Zip
Dependents (exclude self) Ages
Name of nearest relative not living with you Relationship
Address City State Zip

INCOME (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 loan.)

Salary (Gross Net) $ Monthly Bi-weekly Weekly
*Other income Monthly Bi-weekly Weekly

Is any income listed likely to be reduced before this loan is paid off? YesNo
If Yes, explain

Share Draft or Checking Account No. Where?
Share or Savings Account No. Where?

If you have lived at your present residence less than 2 years, complete the following information. Years there?
Address City State Zip Code

If have been employed less than 3 years, complete the following information. Years there?
Previous EmployerEmployers Address

OUTSTANDING DEBITS (List Everything, use separate sheet if needed)

Creditor
CREDITORS NAME
PRESENT BALANCE
MONTHLY PAYMENT
PAST DUE

Yes or No
Rent
Mortgage
AutoLoan
CreditUnion
Credit Card
Credit Card
Other

Are there any other persons obligated on any of the above loans? Yes No
Which ones and who?

Are you a co-signer or guarantor on any loan? Yes No
If yes, For whom? To whom?

Have you been declared bankrupt in the last 10 years? Yes No

Everything that I have stated in this application is correct to the best of my knowledge.  You are authorized to check my credit and employment history and to answer any questions about you credit experience with me.
Signature of Member Date