Secure Loan Application Form

1817 West Broadway Columbia, MO 65218
Phone: (573) 214-4207 | Fax: (573) 214-4796


Type Of Loan Applying For
Joint Credit: Each Applicant must individually complete the appropriate section below, If Co-Borrower is spouse of the Applicant,- mark the Co-Applicant box.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.
Check below to indicate the type of account(s) and type of credit for which you are applying. Married Applicants may apply for a separate account.

* Email Address

* Account / Loan: Individual Joint

Amount Requested: $ .00      Term in Months:      Purpose:

Type of Credit Applied For: New or Used Auto New or Used RV New or Used Boat Signature Share Secured

Payment Method: Payroll Deduction Coupons Automatic Payment

Year
Make
Model
VIN Number
Mileage
Sales Price
$ .00
$ .00
$ .00

Options: Leather Seats Sun Roof 4 Wheel Drive Navigation Rear Entertainment

Seller:

Sales Person:

Phone Number:



Employee Information
Check Please select your current position with Shelter Insurance Companies.
Employee                          Employee Retired                          Employee Family Member
Agent                                Agent Retired                                 Agent Family Member                     Other



Applicant Information
* Applicant's Name:
Driver License #:
* Social Security #:
* Birthdate:
Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:
Marital Status:
Home Phone #:
Mobile Phone #:
* Street Address:
* City: * State:
* Zip #:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Driver License #:
Social Security #:
Birthdate:
Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:
Marital Status:
Home Phone #:
Mobile Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:


Employment Information
* Applicant Employer's Name:
* Employer Phone #:
Employer Address:
* Department:
Supervisor:
* Position:
* Date Hired (MM/DD/YY):
* Monthly or Hourly Income ($):
Other Income ($): per Month
Other Income Source:
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
Joint App. Employer's Name:
Employer Phone #:
Employer Address:
Department:
Supervisor:
Position:
Date Hired (MM/DD/YY):
Monthly or Hourly Income ($):
Other Income ($): per Month
Other Income Source:
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:

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.



Debts & Assets
Lender
Type
Balance
Payment
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
Child Support Payments / Alimony $
Financial Information - please answer the following questions.
Applicant
Co-Applicant
*Have you ever filed for bankruptcy in the past 10 years
*Do you have any outstanding Judgments?
*Have you been obligated on any loan resulting in a repo, foreclosure, or judgement?
*Are you obligated to pay alimony, child support, or separate maintenance?
*Are you co-maker, co-signer or guarantor on any loan not listed above?
*Are you other than a U.S. citizen or permanent resident alien?
*If yes to an of the above questions, please explain.


References (Nearest relative not living with you)
First Name: Middle Name: Last Name: Suffix:
   Home Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?


Submit Application

Notices
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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