Loan Application

Lawrence Memorial Credit Union	NMLS #477121
NMLS #405027	NMLS #1368414

Welcome to Lawrence Memorial Credit Union’s 24-hour online loan application. Please complete all requested information and then submit form as indicated at bottom of page. A Loan Officer will be in contact with you about the status of your new loan.

*Required Fields

Getting Started
Member #*:	Will there be a co-applicant?*	Type of Loan Requested: *¹
	yesno
Amount Requested*:	Loan Term Requested*:	Collateral Description: (if applicable)

¹If an auto loan, provide	Year:	Make:	Model:	Mileage:
year, make, model and mileage:

Personal Information
Applicant
Last Name*	First Name*	M.I.

SSN (9-digits only)*	Birthdate (mm/dd/yy)*

Address*	City*	State*	Zip Code*

Marital Status*	# of Dependents*

Rent or Own?*	Years There*	Rent/Mortgage*
RentOwn
Home Phone*	Work Phone*	Cell Phone
() -Second partThird part	() -Second partThird part	() -Second partThird part
Email Address*	Preferred Contact Method

Personal Information
Co-Applicant
Last Name	First Name	M.I.

SSN (9-digits only)	Birthdate (mm/dd/yy)

Address	City	State	Zip Code

Marital Status	# of Dependents

Rent or Own?	Years There	Rent/Mortgage
RentOwn
Home Phone	Work Phone	Cell Phone
() -Second partThird part	() -Second partThird part	() -Second partThird part
Email Address	Preferred Contact Method

Employment & Income
Applicant
Employer*	Start Date* (mm/dd/yy)	Employer Phone*	Job Title*
		() -Second partThird part

Gross Income*	Select One	Weekly Hours*

Other Income*	Source
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.

NOTE: If less than 2 years at current employer, please provide the following information:

Previous Employer	Start Date (mm/dd/yy)	End Date (mm/dd/yy)	Job Title

A copy of a current paystub from each job currently held by applicant and co-applicant (if applicable) must be provided prior to approval. Paystub copies can be faxed to 860-444-3784

Employment & Income
Co-Applicant
Employer	Start Date (mm/dd/yy)	Employer Phone	Job Title
		() -Second partThird part

Gross Income	Select One	Weekly Hours

Other Income	Source
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.

Previous Employer	Start Date (mm/dd/yy)	End Date (mm/dd/yy)	Job Title
NOTE: If less than 2 years at current employer, please provide the following information:

A copy of a current paystub from each job currently held by applicant and co-applicant (if applicable) must be provided prior to approval. Paystub copies can be faxed to 860-444-3784.

Payment Protection*
Payment Protection* Preserve your financial future. Payment protection coverages provide a valuable safety net by making loan payments in the event of disability or death of a covered member. Your election of the coverages offered below is only a statement of intent. Payment protection options and enrollment will be finalized by the credit union. Click here to obtain a quote without obligation then indicate your interest below.
Yes – Provide Term Life and Disability Coverage* Yes – Provide Disability Coverage only* Yes – Provide Term Life only* Yes - Provide GAP (Guaranteed Asset Protection)* No – Not at this time*
*Not available for Home Equity Loans

Other Important Information
If loan is for debt consolidation, please indicate creditor, account # and description of debts to be paid.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT:
To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your 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.

If you are applying for VISA CREDIT CARD:
SECURITY AGREEMENT AND PLEDGE: By submitting this application, acceptance or authorized use of any credit card(s) issued, I/we pledge our shares as defined by our Membership Agreement to secure payment of my/our obligations on this account Additional Security: I/we understand that collateral securing other loans will secure this account; and that property purchase with my/our credit card(s) will also secure this account. Click here for the Disclosures.

Submitting Your Application:
You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension, or collection of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federally chartered credit unions insured by NCUA.

Comments

Please include any additional comments in the box below.

Prior to submitting this application, please enter the security code in the box below.