NuVista Federal Credit Union - Consumer Loan Application

To apply for a Consumer Loan (Auto, Recreational Vehicle, Vehicle Refinance, etc…) please complete the application below. There is a $25.00 Loan Application Fee.

Please read these instructions before completing this Application and choose the correct type of credit in the box below.

Individual

If you are applying for individual credit in your own name, and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Sections B and E. If the requested credit is to be secured, also complete Section D and Section F.

Joint

If you are applying for joint credit with another person, complete all Sections except F, providing information in C about the joint applicant. If the requested credit is to be secured, then complete Section F.

** OR **

If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete all Sections except F to the extent possible, providing information in C about the person on whose alimony, support, or maintenance payments or income or assets you are relying. If the requested credit is to be secured, then complete Section E.

* - Indicates required field

Section A - Type of Credit

Type of Credit Requested*

Individual
Joint, or Individual with other income

Important information about procedures for opening a new account

To help the government fight the funding of terrorism and money laundering activities, the USA Patriot Act requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, physical address, date of birth, taxpayer identification number and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. We will let you know if additional information is required.

Amount Requested*

Preferred Payment Due Date Desired*

Proceeds of credit to be used for*

Loan Application Fee Payment Information

I/We authorize a $25.00 loan application fee. Choose one option:

How would you like to pay the loan application fee?*

Deduct from my/our NuVista Account #
Process my Debit/Credit Card Number

Section B - Individual Applicant

Your Information

Last Name*

First Name*

Age*

Date of Birth (mm/dd/yyyy)*

Are you a U.S. citizen?*

YesNo

If U.S. Person or non-U.S. (Complete all that apply)

Driver's License Number*

State*

Date of Issuance* (mm/dd/yyyy)

Date of Expiration* (mm/dd/yyyy)

SSN or TIN*

Other ID

Contact Information

Physical Address*

City*

State*

Zip Code*

How long at present address?*

Phone*

Email Address*

Employment History

Present Employer (Company Name and Address)*

How long with present employer?*

Your Position or Title*

Name of Supervisor*

Business Phone*

Previous Employer (Company Name and Address)

How long with previous employer?

Income

Your present gross salary or commission*

Per*

Your present net salary or commission

Per

Alimony, child support, separate maintenance received under:

Court Order
Written Agreement
Oral Understanding

Other Income

Per

Sources of other income

Income Total

References

Relative One*

Relationship*

Phone Number*

Relative Two*

Relationship*

Phone Number*

Section C - Joint Applicant or Other Party

Your Information

Last Name

First Name

Age

Date of Birth (mm/dd/yyyy)

Are you a U.S. citizen?

YesNo

If U.S. Person or non-U.S. (Complete all that apply)

Driver's License Number

State

Date of Issuance (mm/dd/yyyy)

Date of Expiration (mm/dd/yyyy)

SSN or TIN

Other ID

Relationship to Applicant

Contact Information

Physical Address

City

State

Zip Code

How long at present address?

Phone

Email Address

Employment History

Present Employer (Company Name and Address)

How long with present employer?

Name of Supervisor

Your Position or Title

Business Phone

Previous Employer (Company Name and Address)

How long with previous employer?

Income

Your present gross salary or commission

Per

Your present net salary or commission

Per

Alimony, child support, separate maintenance received under:

Court Order
Written Agreement
Oral Understanding

Other Income

Per

Sources of other income

Income Total

Is any income in this section likely to be reduced before the credit requested is paid off?

YesNo

If yes, explain

References

Relative One

Relationship

Phone Number

Section D - Marital Status

(Do not complete if this is an Application for individual unsecured credit.)

Applicant

Married
Separated
Unmarried (single, divorced, widowed)

Other Party

Married
Separated
Unmarried (single, divorced, widowed)

Section E - Asset & Debt Information

If Section C has been completed, this Section should be completed, giving information about both the Applicant and Joint Applicant or Other Person. Please mark Applicant-related with an "B". If Section C was not completed, only give information about the Applicant in this Section.

Assets Owned

Outstanding Debts

(Include charge accounts, installment contracts, credit cards, rent, mortgages, etc. Use separate sheet if necessary)

Mortgage or Rent

Landlord or Mortgage Holder

Type of Debt

Rent PaymentMortgage

Name in which account is carried

Original Debt (Omit Rent)

Present Balance (Omit Rent)

Monthly Payments*

Past Due?

YesNo

Creditor 1

Creditor Name

Type of Debt or Account Number

Name in which account is carried

Original Debt

Present Balance

Monthly Payments

Past Due?

YesNo

Creditor 2

Creditor Name

Type of Debt or Account Number

Name in which account is carried

Original Debt

Present Balance

Monthly Payments

Past Due?

YesNo

Creditor 3

Creditor Name

Type of Debt

Name in which account is carried

Original Debt

Present Balance

Monthly Payments

Past Due?

YesNo

Credit References (Paid off accounts)

Reference 1

Creditor

Type of Debt or Account Number

Name in which account is carried

Original Debt

Date Paid Off (mm/dd/yyyy)

Reference 2

Creditor

Type of Debt or Account Number

Name in which account is carried

Original Debt

Date Paid Off (mm/dd/yyyy)

Additional Information

Are you a co-maker, endorser, or guarantor on any loan or contract?*

YesNo

Are there any unsatisfied judgments against you?*

YesNo

Have you been declared bankrupt in the past 10 years?*

YesNo

Section F - Secured Credit

Complete only if credit is to be secured.

Property Description

If vehicle, please complete:

Color

Model

Plate Number

Credit Application Signatures

CREDIT DISCLOSURES

An insurance product or annuity may be offered to you. If you purchase an insurance product or an annuity: (1) The insurance product or annuity is not a deposit or other obligation of, or guaranteed by, this institution or our affiliate(s); (2) With exception of Federal Flood Insurance or Federal Crop Insurance, the insurance product or annuity is not insured by the Federal Deposit Insurance Corporation or any other agency of the United States, this institution, or our affiliate(s); and (3) In the case of an insurance product or annuity that involves an investment risk, there is investment risk associated with the insurance product, including the possible loss of value. If an insurance product or annuity is offered we cannot condition an extension of credit on either of the following: (1) Your purchase of an insurance product or annuity from us or any of our affiliates; or (2) Your agreement not to obtain, or a prohibition on you from obtaining, an insurance product or annuity from an unaffiliated entity.

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