Jeffco Credit Union - Secure Loan Application
Please Enter your Email Address:



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:

Requested Amount:
Purpose:
Term in Months:

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: Joint Applicant:
Name: Name:
Account #: Account #:
Social Security #: Social Security #:
Birthdate (MM/DD/YY): Birthdate (MM/DD/YY):
Primary Phone #: Primary Phone #:
Present Address: Present Address:
Address Line 2: Address Line 2:
City: City:
State & Zip: State & Zip:
Current Address since: (MM/YY): Current Address since: (MM/YY):
If less than 3 yrs enter previous address: 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 303-278-4636, Attention: Loan Department. If self-employed or retired, financial statement or income tax returns will be needed.

Applicant: Joint Applicant:
Employer Name: Employer Name:
Employer Phone #: Employer Phone #:
Employer Address: Employer Address:
Position: Position:
Date Hired (MM/DD/YY): Date Hired (MM/DD/YY):
Monthly Gross Income: $ Monthly Gross Income: $
Other Income per Month: $ 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:
Joint Applicant:
Complete if current is less than 2 years:
Previous Employers Name: Previous Employers Name:
Years Employed: Years Employed:

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


Applicant: Joint Applicant:
Creditor: Monthly Payment: Creditor: Monthly Payment:
Housing Rent Own None Housing Rent Own None

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.



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