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Please answer every question.

Notice: We may report information about your account to credit bureaus. Late payment and other defaults on your account may be reflected in your credit report.

Member Number:

Loan Information:

Type of Loan Applied For: Personal (Signature)   Share Secured   New Car   Used Car   Boat   Travel Trailer/Camper   Motorcycle/ATV   Other:
Amount Applied For:		Purpose:	Desired Repayment Length (months):
Security Offered: Year:	Make:	Model:	VIN #:

Applicant:			Joint Applicant:
Last Name	First	MI	Last Name	First	MI
Social Security #		Birth Date (mm/dd/yyyy)	Social Security #		Birth Date (mm/dd/yyyy)
Drivers License #		State	Drivers License #		State
Present Address			Present Address
City	State	Zip	City	State	Zip
Current Address Since	If < 2 yrs, Previous Addr.	Yrs at Previous Addr.	Current Address Since	If < 2 yrs, Previous Addr.	Yrs at Previous Addr.
Home Phone	Cell Phone	Work Phone	Home Phone	Cell Phone	Work Phone
US Citizen Yes   No	Number of Dependents Living With You		US Citizen Yes   No	Number of Dependents Living With You
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, Widowed, Divorced)			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, Widowed, Divorced)
Employment and Income:
Employer Name			Employer Name
Employer Address			Employer Address
City	State	Zip	City	State	Zip
Employer Phone #	Department		Employer Phone #	Department
Supervisor	Position		Supervisor	Position
Date Hired	Monthly Gross Income	Other Monthly Income	Date Hired	Monthly Gross Income	Other Monthly Income
Previous Employer Name		Yrs Employed	Previous Employer Name		Yrs Employed
In order to expedite the processing of your loan application, please fax your 2 most recent pay stub copies to (800)886-0339 -- Attention: Loan Department. If self-employed or retired, last 2 years complete income tax returns will be needed Note: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for this credit request.
Credit Information: Please list all accounts with a balance.
Creditor		Monthly Payment	Creditor		Monthly Payment
Housing Rent   Own   None   Family			Housing Rent   Own   None   Family
Child Support Payment			Child Support Payment
Other			Other
Other			Other
Other			Other
Other			Other
Other			Other

References - 3 Nearest Relatives Not Living With Member:
Name			Name			Name
Phone #			Phone #			Phone #
Street Address			Street Address			Street Address
City	State	Zip	City	State	Zip	City	State	Zip
Relationship			Relationship			Relationship

Income and History:
Is your income likely to decline in the next 2 years? Yes   No	Have you ever filed for bankruptcy or had repossession? Yes   No
Are you a cosigner on any other loan? Yes   No	Are there any judgments or liens against you? Yes   No
If a yes answer is given to any of the above questions, please provide an explanation:
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 joint applicant section about your spouse if: You live in or the property pledged as collateral is located in a community property state (AZ,CA,ID,LA,NM,NV,TX,WA,WI) Your spouse will use the account or You are relying on your spouse's income as a basis for repayment. If you are applying for joint credit with another person, complete the applicant and joint applicant sections.

Payment Protection Coverage:
Check coverage(s) desired. The Credit Union will disclose the cost of this voluntary insurance to you. A separate enrollment form which disclose the terms and conditions must be signed for coverage to become effective.
Single Credit Disability/ Single Credit Life Single Credit Disability/Single Involuntary Unemployment/ Single Credit Life Single Involuntary Unemployment/Single Credit Life		Joint Credit Disability/ Joint Credit Life Joint Credit Disability/Joint Involuntary Unemployment/ Joint Credit Life Joint Involuntary Unemployment/Joint Credit Life		Single Credit Life Insurance   Joint Credit Life Insurance   Rejected

How Can We Contact You:
Home Phone #	Cell Phone #	Work Phone #
Email Address:		Best Time of Day to Contact:

Signature:
By signing this application (typing your signature below) for credit and pressing the "Submit Application" button you agree that everything stated herein is correct to the best of your knowledge. In addition, the creditors you have listed is a complete list of what you owe. If there are any changes, you will notify us in writing immediately. You authorize Southwest Heritage Credit Union to obtain credit reports in connection with this application for credit, and for any update, increase, renewal, or extension of the credit received. You understand that 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 or state chartered Credit Unions insured by NCUA. We may report information about you account to credit bureaus. Late payments, missed payments or other defaults on your account may be reflected in your credit report.
Required: I have read and understood the terms of the disclosure above.
Applicant Signature		Date
Joint Applicant Signature		Date

Please click on the "Submit Application" button to send your application.

One of our representatives will respond to your submission as soon as possible.