PIAS Credit Union Loan Application Page

PIASCredit Union

LOAN APPLICATION

Please complete this form on screen, print it out, sign where indicated and
mail, fax or bring it to the credit union.

(If you have questions, please call one of our Loan Officers for help at (615) 360-9951 or
(800) 264-4655 during our normal business hours: 7:30a - 4:30p Central time.)

Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself and the Co-Applicant section about your spouse if:

Your spouse will use the account, or
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 Co-Applicant section to the extent possible about the person on whose payments you are relying.
If you are applying for Joint Credit with another person, complete the Applicant and Co-Applicant sections.

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:	How Many? Periods:
Loan Type:
Security Offered:	(for secured credit only)
Type of Credit:	Individual Joint

Payment Protection Coverage (check if desired)

Find out more about Payment Protection Insurance and why it's a better consumer value when offered through your credit union.

Check coverage(s) desired. We will disclose the cost of this Payment Protection Insurance - Credit Disability and Credit Life - to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.

Yes No

Do you want your loan protected for you and your family if you become disabled?

Yes No

Do you want your loan protected for you and your family in the event of your death?

Tell Us About Yourself

Applicant	Co-Applicant
Name:	Name:
CU Account #:	CU Account #:
Social Security #:	Social Security #:
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state: Married Separated Unmarried (Single - Divorced - Widowed)	Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state: Married Separated Unmarried (Single - Divorced - Widowed)

Driver's License #: State:	Driver's License #: State:
Birth Date:	Birth Date:
Home Phone: Business Phone:	Home Phone: Business Phone:
Present Address: Years There: Own Rent	Present Address: Years There: Own Rent

Debts	Debts
Mortgage/Rent owed to:	Mortgage/Rent owed to:
Balance (Mortgage only):	Balance (Mortgage only):
Monthly Payment: Current APR % (Mortgage only):	Monthly Payment: Current APR % (Mortgage only):
Person Responsible for Payment:	Person Responsible for Payment:
Income	Income
Employer:	Employer:
Income: $ Net Gross Annual Monthly Bi-weekly Weekly	Income: $ Net Gross Annual Monthly Bi-weekly Weekly
Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.) Source: $ Annual Monthly Hourly	Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.) Source: $ Annual Monthly Hourly

Signatures:

You promise that everything you have stated in this request is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You also agree to notify us of any change in your name, address or employment within a reasonable time thereafter. You authorize the credit union to obtain credit reports in connection with this request. 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. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on requests made to Federal Credit Unions or State Chartered Credit Unions insured by the NCUA. You understand that the credit union will rely on the information in the request and your credit report to make its decision.

X____________________________________________
Applicant Signature and Date

X____________________________________________
Co-Applicant Signature and Date

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