Loan Application * Required Fields Effective October 1, 2003 In accordance with section 326 of the USA Patriot Act, Gale Credit Union is required by Federal law to obtain, verify, and record information that identifies each person who opens an account or is being added as a signatory to a new or existing account. In some cases, identification will be requested for those banking with us prior to the effective date of the customer identification requirements because original documentation was not obtained with the opening of the accounts. What this means for you: When you open an account or are going to be added as a signatory to an account, we will ask for you name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. Member Type: Current Member New Member Member Number: Purpose of Loan: Term: Select... 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years Amount Requested: Applying for a Joint Account: Yes No This application initiates the loan process. Final signature(s) will be required to advance funds, including signatures for joint applicants. We will contact you the next business day. PLEASE TELL US ABOUT YOURSELF (PRIMARY BORROWER) Full Name: Street Address: Street Address: Address Second Line City: State: Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP: Years There: Cell Phone: Home/Work Phone: Social Security Number: Birth Date: Birth Date: Month Month... January February March April May June July August September October November December / Birth Date: Day Day... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Birth Date: Year Year... 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 Email Address: PLEASE TELL US ABOUT YOUR JOB (PRIMARY BORROWER) Current Employer: Years There: Phone Number: Position: Gross Monthly Income: Note: alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation Other Income: Source: PLEASE TELL US ABOUT YOURSELF (CO-BORROWER)Only if Joint is Checked Full Name: Street Address: Street Address: Address Second Line City: State: Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP: Years There: Cell Phone: Home/Work Phone: Social Security Number: Birth Date: Birth Date: Month Month... January February March April May June July August September October November December / Birth Date: Day Day... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Birth Date: Year Year... 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 Email Address: PLEASE TELL US ABOUT YOUR JOB (CO-BORROWER) Current Employer: Years There: Phone Number: Position: Gross Monthly Income: Note: alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation Other Income: Source: PLEASE LIST NEAREST RELATIVE NOT LIVING WITH YOU Full Name: Home Address: Home Address: Address Second Line City: State: Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP: Phone Number: Collateral: Select... Vehicle Certificate Deposit Account Home Other None Monthly Payments Mortgage Description of Debt: Payment to: Monthly Payment: Balance Owed: Rent Description of Debt: Payment to: Monthly Payment: Auto Description of Debt: Payment to: Monthly Payment: Balance Owed: Auto 2 Description of Debt: Payment to: Monthly Payment: Balance Owed: Charge Card Description of Debt: Payment to: Monthly Payment: Balance Owed: Other Description of Debt: Payment to: Monthly Payment: Balance Owed: Amount you pay in alimony or child support: Are you a Co-Borrower on any other loans? Yes No If yes, for whom: Where: Monthly Payment: AGREEMENT DISCLAIMER: I/WE HEREBY CERTIFY THAT ALL STATEMENTS MADE ARE TRUE AND COMPLETE, ARE SUBMITTED FOR THE PURPOSE OF OBTAINING CREDIT, AND THAT THE CREDIT UNION MAY RELY ON THEM FOR SUCH DETERMINATION. WE UNDERSTAND THAT FEDERAL LAW REQUIRES THE VERIFICATION OF IDENTIFICATION FOR ALL NEW ACCOUNTS SHOULD I NOT HAVE AN EXISTING ACCOUNT. I/WE AUTHORIZE YOU TO OBTAIN SUCH INFORMATION AS YOU MAY REQUIRE CONCERNING THE STATEMENTS MADE IN THIS APPLICATION AND PROPER IDENTIFICATION, AND AGREE THAT THE APPLICATION SHALL REMAIN YOUR PROPERTY, AND YOU ARE AUTHORIZED TO ANSWER QUESTIONS ABOUT YOUR CREDIT EXPERIENCE WITH ME/US. I accept the terms of the disclaimer above and submit my application.: Yes Security Code: Security Code Go to main navigation