DOCO Credit Union

LOAN APPLICATION - CONSUMER
PLEASE COMPLETE ALL SECTIONS. RED SELECTIONS ARE REQUIRED (If a required field does not apply to you type N/A)
  DATE APPLICANT ACCOUNT NUMBER
 Personal Collateral Secured Other
  Amount Requested $  Purpose of Loan
  Collateral Offered
  Repayment: Payroll Deduction Automatic transfer Cash

  MARRIED APPLICANTS MAY APPLY FOR INDIVIDUAL ACCOUNTS. INDICATE BELOW THE TYPE OF CREDIT WANTED
INDIVIDUAL CREDIT: Complete Applicant Section. Complete other section if the following applies: You Live in a community property state (AZ, CA, ID, LA, NM, NV, P.R., TX, WA, WI) or your spouse will use the account - You are relying on your Spouse/Co-Applicant's income as a source of repayment.

  APPLICANT
  Complete for secured credit or if you live in a community property state
Married Seperated Unmarried Single Divorced Widowed
  PREFIX (Mr./Mrs./etc.)
  		 FIRST
 INITIAL
 LAST NAME
 SUFFIX (Jr./Sr./etc.)
  SOCIAL SECURITY NO. BIRTHDATE HOME PHONE CELL PHONE
  BEST CONTACT NUMBER DURING THE DAY  
  EMAIL  
NO. OF DEPENDENTS AGE OF DEPENDENTS
OWN RENT OTHER AMOUNT  
CURRENT ST. ADDRESS APT. NO HOW LONG
CITY STATE ZIP
FORMER STREET ADDRESS  
CITY STATE ZIP
LANDLORD LANDLORD PHONE
MAILING ADDRESS  
APT. NO  
CITY STATE ZIP
  EMPLOYMENT AND INCOME
CURRENT EMPLOYER HIRE DATE
STREET ADDRESS WORK PHONE NO. EXT
CITY STATE ZIP
POSITION MONTHLY GROSS INCOME $
  SUPERVISOR'S NAME AND PHONE #
  FORMER EMPLOYER-If less than 2 years with current employer must complete
  
START DATE
END DATE

  OTHER INCOME
  You need not list income from alimony, child support or separate maintenance unless you wish it to be considered for purposes of granting this credit.
  SOURCE OF OTHER INCOME
  		 PHONE
 SINCE
 MONTHLY INCOME $

  CO-APPLICANT
  Complete for secured credit or if you live in a community property state
MARRIED SEPARATED UNMARRIED Single Divorced Widowed
  FIRST
  		 INITIAL
 LAST NAME
  SOCIAL SECURITY NO. BIRTHDATE HOME PHONE CELL PHONE
  BEST CONTACT NUMBER DURING THE DAY  
  EMAIL 
NO. OF DEPENDENTS AGE OF DEPENDENTS
OWN RENT OTHER AMOUNT
CURRENT STREET ADDRESS APT. NO HOW LONG
CITY STATE ZIP
FORMER ST. ADDRESS YEARS THERE
CITY STATE ZIP
LANDLORD LANDLORD PHONE
MAILING ADDRESS  
APT. NO  
CITY STATE ZIP
  EMPLOYMENT AND INCOME
CURRENT EMPLOYER HIRE DATE
  STREET ADDRESS WORK PHONE NO. EXT
CITY STATE ZIP
POSITION MONTHLY GROSS INCOME
  SUPERVISOR'S NAME AND PHONE #
  FORMER EMPLOYER-If less than 2 years with current employer must complete
  
START DATE
END DATE

  OTHER INCOME
  You need not list income from alimony, child support or separate maintenance unless you wish it to be considered for purposes of granting this credit.
  SOURCE OF OTHER INCOME
  		 PHONE
 SINCE
 MONTHLY INCOME $

  PERSONAL REFERENCES INDICATE A = Applicant C = Co-Applicant
  NEAREST RELATIVE NOT LIVING WITH YOU
A C NAME ADDRESS
CITY STATE ZIP
PHONE RELATIONSHIP
  PERSONAL FRIEND - NOT A RELATIVE
A C NAME ADDRESS
CITY STATE ZIP
PHONE RELATIONSHIP
  ASSETS
CHECKING SAVINGS

  FINANCIAL INSTITUTION FINANCIAL INSTITUTION
  APPROXIMATE BALANCE $ APPROXIMATE BALANCE $
  CAR 1: YEAR/MAKE
  
PLEDGEDYN		 CAR 2: YEAR/MAKE
PLEDGEDYN
  REAL ESTATE
  		 VALUE $
 OTHER
 VALUE $

  OUTSTANDING DEBTS AND OBLIGATIONS
  Be sure to list all open accounts with a balance, include child support, alimony and IRS obligations, etc.
A = APPLICANT
C = CO-APPLICANT		      
INDICATE CODE
A or C		 LIST ALL REGULAR MONTHLY DEBTS OWED BALANCE MONTHLY PAYMENTS

  Please answer the following questions.
  Please indicate A= Applicant C = Co-Applicant A
YES     NO		 C
YES     NO
  1. Have you ever filed a petition for bankruptcy?
  Date
  2. Have you ever had an auto or furniture repossessed or property foreclosed upon?
  Date
  3. Are you a co-maker or co-signer of any loan or lease?
  For whom?
  Where ?
  4. Do you have any past due bills?
  5. Is any income you have listed likely to be reduced in the next two years?
  6. Have you ever had credit in any other name?
  What name?
  7. Have you any suits pending, judgments filed, alimony or support awards against you?
  8. Are you other than a U.S. Citizen or permanent resident alien?

  Would you like information on payment protection?
 YES     NO
  Would you like to have your loan payments deducted from your payroll or automatically trasferred from your account? YES    NO
By submitting this application to DOCO Credit Union, I/we promise that everything is correct to the best of my/our knowledgeand that the above information is a complete listing of my/our debts and obligations. I/we authorize the Credit Union to obtaincredit reports in connection with this loan application and for any update or extension of the credit received. I/we understand that the Credit Union will rely on both the representations I/we make in this application and the contents of any credit report it obtains when deciding whether to grant the credit requested. I/we agree to immediately notify you of changes to any of the information provided in this application. I/we agree that my/our account will be subject to the terms and conditions of all applicable agreements and disclosures that will accompany the funds when issued; and that a photocopy or facsimile of this application shall be as binding as the original.

By submitting this application electronically, I/we agree to the same terms that apply to a signed application. If there is a co-applicant on this loan, that co-applicant has authorized the submission of this application. This electronic submission qualifies as my/our signature.

Note: Make sure all required fields are completed correctly.
  You may submit your completed and signed form to DOCO by either faxing it to (706) 886-0663, mailing it to DOCO Credit Union, P.O. Box 71389, Albany, GA 31708-1389 or returning it to us in person at any branch office.
Thank you.