contents
contents2


Jeffco Federal Credit Union - Secure Loan Application

Please Enter your Email Address:

If you are applying for joint credit, secured credit or if you live in a community property state (AZ,CA,ID,LA,NM,NV,TX,WA,WI,Puerto Rico), please complete the following:

--------------------------------------------------------------------------------------------------------------------------------------
Type of Loan Applied For:
Personal (Signature)
-- Visa Share Secured Unsecured Line of Credit New Car Used Car Home Equity Mortgage Commercial Investment Property Modular home-- Other:

Amount applied for: $
Purpose:
Desired Length of Repayment (mon):

Method of Payment:
Coupons Payroll Deduction Automatic Transfer from Savings Checking

Are you a U.S. Citizen?
Yes No

Have you ever had a judgment, bankruptcy, repossesion, or lawsuit?
Yes No

Do you own your home or vehicle?
Home Value: $ -- Vehicle(s) Value: $


--------------------------------------------------------------------------------------------------------------------------------------
Applicant:
Name:
Account #:
Social Security #:
Birthdate (MM/DD/YY):
Home Phone #:
Present Address:
Street:
City:
State & Zip:
Current Address since: (MM/YY):
If less than 3 yrs enter previous address:

Joint Applicant:
Name:
Account #:
Social Security #:
Birthdate (MM/DD/YY):
Home Phone #:
Present Address:
Street:
City:
State & Zip:
Current Address since: (MM/YY):
If less than 3 yrs enter previous address:

--------------------------------------------------------------------------------------------------------------------------------------
Employment and Income: In order to expedite the processing of your loan application please fax your paystub copies to (303) 278-4680, Attention: Loan Department. If self-employed or retired, financial statement or income tax returns will be needed.

Applicant:
Employer Name:
Employer Phone #:
Employer Address:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income: $
Other Income: $ per Month
Joint Applicant:
Employer Name:
Employer Phone #:
Employer Address:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income: $
Other Income: $ per Month

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.

Applicant:
Complete if current is less than 2 years:
Previous Employers Name:
Years Employed:
Joint Applicant:
Complete if current is less than 2 years:
Previous Employers Name:
Years Employed:

--------------------------------------------------------------------------------------------------------------------------------------
Credit Information : Please list all open Accounts with a balance.

Applicant:
CREDITOR:
MONTHLY
PAYMENT:
Joint Applicant:
CREDITOR:
MONTHLY
PAYMENT:
Housing
Rent Own None

Housing
Rent Own None


--------------------------------------------------------------------------------------------------------------------------------------
VISA Credit Card Disclosure:

Annual Percentage Rate: 8.9% to 12.9% (Periodic rate used to compute the Finance Charge is 0.7416 to 1.075% per month.)

Grace period: Purchases-25 days Cash Advances accrue interest from the date they are posted to the account.

Method of Computing the Balance: Average Daily Balance Method (including new purchases).

Annual Fee: $12.00

Minimum Finance Charge: NONE

Transaction Fee for Purchases: NONE

Other Charges: Over-the-Credit-Limit Fee - $0.00; Late Payment Fee - $0.00

You agree that everything stated in this application is correct to the best of your knowledge. The Credit Union is authorized to investigate your creditworthiness, employment history, and to obtain a credit report and to answer questions about their credit experience with you. You understand that any false or misleading statement in your application may cause any loan or extension of credit to be in default. You authorize us to accept your facsimile signatures on this application and agree that your facsimile signature will have the same legal force and effect as your original signature. You assume any risk that may be associated with permitting us to accept your facsimile signature.

By pressing the "Send Application" button below, you agree to the above statement. You understand that we may require your signature on additional documents prior to disbursing any credit proceeds.

-------


equal_housing


ncua

The National Credit Union Administration (NCUA), a U.S. Government agency, federally
insures member deposits up
to $100,000. Individual Retirement Accounts are separately insured to $250,000 each.


ehl