St. Agnes Employees Credit Union - Secure Loan Application
Please Enter your Email Address:

You may apply for individual or joint credit, but check only one of the following options.
Individual Credit (Unmarried) Individual Credit (Married) Complete Applicant & Joint Applicant Section Joint Credit (With Spouse) Joint Credit (With Comaker)

Type of Loan Applied For:
Personal (Signature) New Car Used Car
Home Other:

Requested Amount:
Term in Months:


Method of Payment:
Coupons Payroll Deduction Automatic Transfer

Are you a U.S. Citizen?
Yes No

Payment Protection Plan
Would you like to purchase Credit Life Insurance?
Single Credit Life None

Would you like to purchase Credit Disability Insurance?
Single Disability None

Applicant: Joint Applicant:
Name: Name:
Account #: Account #:
Social Security #: Social Security #:
Birthdate (MM/DD/YY): Birthdate (MM/DD/YY):
Home Phone #: Home Phone #:
Cell Phone #: Cell Phone #:
Work Phone #: Work 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):

Employment and Income: In order to expedite the processing of your loan application please fax your paystub copies to (920)-926-8996, 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.

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

I/we certify that this information on all pages has been supplied truthfully, accurately and voluntarily, and therefore authorize this credit union to investigate our creditworthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means for consideration for the loan applied for herein, or for any other service offered by this credit union or its affiliate. The credit union may release information about its credit experience with me/us as permitted by law. If this application is for the purpose of encumbering real property, I/we agree to pay all allowable expenses incurred in processing this application whether or not the loan is approved. This application does not constitute a contract for the extension of credit. I/we understand that it may be a Federal crime punishable by fine or imprisonment or both to knowingly make any false statements concerning any of the above facts, as applicable under the provisions of Title 18, United States Code, Section 1014.

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.