CHICAGOLAND ELECTRICAL INDUSTRY CREDIT UNION
LOAN APPLICATION


Member Account Number __________________________________

If you are applying for credit in your name only, do not complete portion on co-applicant.
 
APPLICANT NAME (LAST - FIRST - MIDDLE)
 		 CO-APPLICANT NAME (LAST - FIRST - MIDDLE)
HOME ADDRESS (STREET & NO.)
 		 HOW LONG? HOME ADDRESS (STREET & NO.) HOW LONG?
CITY - STATE - ZIP
 		 CITY - STATE - ZIP
PREVIOUS HOME ADDRESS
 		 HOW LONG? PREVIOUS HOME ADDRESS HOW LONG?
HOME PHONE NO.
 		 BIRTH DATE NO. OF DEPENDENTS              AGES HOME PHONE NO. BIRTH DATE RELATIONSHIP TO APPLICANT
SOCIAL SECURITY NO.                                               DRIVERS LICENSE NO. AND STATE
 		 SOCIAL SECURITY NO.                                         DRIVERS LICENSE NO. AND STATE
BUSINESS PHONE NO.
 		 GROSS ANNUAL SALARY
$		 NET MONTHLY PAY BUSINESS PHONE NO. GROSS ANNUAL SALARY
$		 NET MONTHLY PAY
EMPLOYER                           POSITION
 		 HOW LONG? EMPLOYER                                     POSITION HOW LONG?
BUSINESS ADDRESS
 		 BUSINESS ADDRESS
PREVIOUS EMPLOYER        POSITION
 		 HOW LONG? PREVIOUS EMPLOYER                   POSITION HOW LONG?
PREVIOUS BUSINESS ADDRESS
 		 PREVIOUS BUSINESS ADDRESS
Alimony, child support, or seperate, maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Alimony, child support, seperate, maintenance received under court order 
written agreement      oral understanding
Other income $_______ per ________ Source(s) of other income: ________________________________________________________
Is any income listed in this Section likely to be reduced in the next two years?
Yes  (Explain in detail on a seperate sheet)    No 		Alimony, child support, seperate, maintenance received under court order  written agreement      oral understanding
Other income $_______ per ________ Source(s) of other income:
________________________________________________________
Is any income listed in this Section likely to be reduced in the next two years?
Yes  (Explain in detail on a seperate sheet)    No
OUTSTANDING DEBTS (Include charge accounts, installment contracts, credit cards, rent, mortgages, etc. Use seperate sheet if necessary).
MORTGAGEE OR LANDLORD PAYMENT ADDRESS APPROX. MARKET VALUE ORIGINAL AMOUNT
$		 BALANCE DUE
$		 MO. PMT./RENT
$
AUTOS OWNED - MAKE YEAR LICENSE NUMBER FINANCED BY $ $ MONTHLY PAYMENT

$
NAME AND ADDRESS (OTHER DEBTS)                                          ACCOUNT NUMBER $ $ $
  $ $ $
  $ $ $
  $ $ $
  $ $ $
CHECK/SHARE DRAFT ACCT. NO.                    LOCATION SAVINGS ACCOUNT NUMBERS                         LOCATION $ TOTAL
NAME OF NEAREST RELATIVE NOT LIVING WITH YOU                        ADDRESS (CITY - STATE - ZIP)                                         RELATIONSHIP
Are you a co-maker, endorser, or                                                                             If "yes"
guarantor on any loan or contract?     Yes       No                                      for whom?                                                  To whom?
Are there any unsatisfied                  Yes                                                               If "yes"
judgments against you?                 No          Amount $                                      to whom owed?
Other obligations - (E.g. liability to pay alimony, child support, seperate maintenance. Use seperate sheet if necessary.)
Have you ever had a car or personal property reposessed by a dealer or finance company, filed for bankruptcy, or been a party to a wage assignment or collection suit, or have you ever been declined on a loan application to this credit union           Yes             No  
If your answer to any part of the questions is yes please give details.
COMPLETE THE FOLLOWING ONLY IF YOU RESIDE IN A COMMUNITY PROPERTY STATE (ARIZONA, CALIFORNIA, IDAHO, LOUISIANA, NEVADA, NEW MEXICO, TEXAS, WASHINGTON OR WISCONSIN), OR IF ANOTHER PERSON WILL BE JOINTLY LIABLE ON THE ACCOUNT.
                                         Married                                             Seperated                                       Unmarried
This statement is submitted to obtain credit and I(We) certify that all information herein is true and complete.   I(We) also authorize the credit union to verify or obtain further information the credit union may deem necessary concerning my(our) credit standing.  If this application is approved and a credit card(s) issued, the undersigned applicant(s) by signing, using or permitting another to use the credit card(s) agree(s) that the applicant(s) will be bound by the terms and conditions accompanying the credit card(s) and all amendments.
APPLICANT'S SIGNATURE         DATE
X		 CO-APPLICANT'S SIGNATURE      DATE
X
FOR CREDIT UNION USE ONLY
   APPROVED       CREDIT COMMITTEE/LOAN OFFICER _________________________________  DATE _______
   OTHER    COMMENTS: __________________________________________________________________________