Augusta Seaboard Community FCU
1212-C Augusta West Parkway
Augusta, GA 30909
Phone: 1-866-805-3744, 706-650-9200
Fax: 706-650-9888
 Loan Application

Individual Credit: 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.
Joint Credit: If you are applying with another person, complete the Applicant and Other sections.
Check below to indicate the type of account(s) and type of credit for which you are applying. Married applications may apply for a separate account
   
LOANLINER Account/Loan:    
   
Individual  
   
Joint    
(Including ATM/Debit Card access to the account if Available)
 
Amount Requested $__________________________________
 
Purpose/Collateral:____________________________________
                     
Repayment:
   
Payroll Deduction 
   
Cash  
   
Military Allotment 
   
Automatic Payment 
   
Other ______________
Married Applicants may apply for separate account. Check the appropriate box to indicate individual credit or Joint Credit.
Applicant
 NAME (last - first - Initial)  MOTHER'S MAIDEN NAME
 DRIVER'S LICENSE NUMBER / STATE
 ACCOUNT NUMBER  SOCIAL SECURITY NUMBER
BIRTH DATE HOME PHONE BUSINESS PHONE / EXT.
  (     ) (     )
PRESENT ADDRESS (Street - City - State - Zip)
   
OWN  
   
RENT  
 
YEARS
AT THIS
ADDRESS 
MORTGAGE/RENT OWED TO:
 MORTGAGE BALANCE
 $ 		 MONTHLY PAYMENT
 $ 		 INTEREST RATE
                       %
COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:
   
MARRIED
   
SEPARATED
   
UNMARRIED (Single - Divorced - Widowed)
EMPLOYMENT/INCOME
NAME AND
ADDRESS OF
EMPLOYER
NOTICE:  : ALIMONY CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED
EMPLOYMENT INCOME OTHER INCOME
$_______________ PER_______________ $_______________ PER_______________
   
JOB TITLE: __________________________ DATE OF EMPLOYMENT: _______________________
   
NET
   
GROSS
  SOURCE______________________________
GUARANTOR   RELATIONSHIP
NAME AND ADDRESS
OF NEAREST
RELATIVE NOT
LIVING WITH YOU 		  HOME PHONE
  Other:      
   
  Co-Applicant    
   
  Spouse  
 NAME (last - first - Initial)  MOTHER'S MAIDEN NAME
 DRIVER'S LICENSE NUMBER / STATE
 ACCOUNT NUMBER  SOCIAL SECURITY NUMBER
BIRTH DATE HOME PHONE BUSINESS PHONE / EXT.
  (     ) (     )
PRESENT ADDRESS (Street - City - State - Zip)
   
OWN  
   
RENT  
 
YEARS
AT THIS
ADDRESS 
MORTGAGE/RENT OWED TO:
 MORTGAGE BALANCE
 $ 		 MONTHLY PAYMENT
 $ 		 INTEREST RATE
                       %
COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:
   
MARRIED
   
SEPARATED
   
UNMARRIED (Single - Divorced - Widowed)
EMPLOYMENT/INCOME
NAME AND
ADDRESS OF
EMPLOYER
NOTICE:  : ALIMONY CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED
EMPLOYMENT INCOME OTHER INCOME
$_______________ PER_______________ $_______________ PER_______________
     
JOB TITLE: __________________________ DATE OF EMPLOYMENT: _______________________
     
   
NET
   
GROSS
  SOURCE______________________________
GUARANTOR   RELATIONSHIP
NAME AND ADDRESS
OF NEAREST
RELATIVE NOT
LIVING WITH YOU 		  HOME PHONE
STATE LAW
NOTICES

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 766.70, or court decree under 766.70 will adversely affect the rights of the Credit Union unless the Credit Unions 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.

X_______________________________________________________________________________
SIGNATURE FOR WISCONSIN RESIDENTS ONLY                               Date

1.  You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes you will notify use in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and any update, increase, renewal or extension 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.
2.  You have received and read the LOANLINER Credit Agreement, including the Addendum("Agreement"), and by signing below you agree to be bound by the terms of the Agreement.
3.  If you are applying for a credit card, you understand that the use of your card will constitute acknowledgment of receipt and agreement to the terms of the credit card agreement and disclosures.
4.  You grant us a security interest in the following share accounts to secure what you owe under the Agreement, and if you have applied for a credit card, under the credit card agreement. When you are in default you authorize us to apply the balance in these accounts to any amounts due. If no dollar amount or account number is indicated below, you authorize us to apply the balance in your individual and joint share accounts at the time of default to pay any amounts due. Shares and deposits in an Individual Retirement Account, and any other account that would lose special tax treatment under state or federal law if given as security, are not subject to the security interest you have given in your shares and deposits.

AMOUNT $__________________       ACCOUNT NO.__________________

AMOUNT $__________________       ACCOUNT NO.__________________ 
       
       
X __________________________________________ X __________________________________________
Applicants Signature                                 Date Other Signature                                 Date
For Credit Union Use Only
DATE     
   
APPROVED

APPROVED

SIGNATURE LINE OF CREDIT OTHER OTHER DEBT RATIO/SCORE
 
   
DENIED
(Adverse Action Notice Sent)		 LIMITS: $ $ $ $ BEFORE      AFTER
LOAN OFFICER COMMENTS:  

X_______________________________________
Signature:                                             Date
X_______________________________________
 Signature:                                           Date
You Must Print, Sign, and Return to Credit Union
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