Fairport Federal Credit Union

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LOANLINER® Loan Application

Fairport Federal Credit Union 70 S. Main St. Fairport, New York 14450

Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself and the Co-Applicant section about your spouse if:

Your spouse will use the account, or
You are relying on your spouse's income as a basis for repayment.

If you are relying on income from alimony, child support or separate maintenance, complete the Co-Applicant section to the extent possible about the person on whose payments you are relying.

If you are applying for Joint Credit with another person, complete the Applicant and Co-Applicant sections.

TYPE AND AMOUNT OF CREDIT YOU'RE REQUESTING
Is this your first loan from us?	Yes No
Amount/Credit Limit Requested:	$
Approximate Time to Repay:	How Many? Periods:
Loan Type:
If other, describe:
Type of Credit:	Individual Joint

PAYMENT PROTECTION COVERAGE

Check if desired

Find out more about Payment Protection Insurance and why it's a better consumer value when offered through your credit union.

Check coverage(s) desired. We will disclose the cost of this Payment Protection Insurance - Credit Disability and Credit Life - to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.

Yes No	Do you want your loan protected for you and your family if you become disabled?
Yes No	Do you want your loan protected for you and your family if you die?

TELL US ABOUT YOURSELF

Applicant	Co-Applicant
Name: Email:	Name:
CU Account #:	CU Account #:
Social Security #:	Social Security #:
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state: Married Separated Unmarried (Single - Divorced - Widowed)	Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state: Married Separated Unmarried (Single - Divorced - Widowed)
Driver's License #: State:	Driver's License #: State:
Birth Date:	Birth Date:
Home Phone: Business Phone:	Home Phone: Business Phone:
Present Address: Years There: Own Rent	Present Address: Years There: Own Rent
DEBTS	DEBTS
Mortgage/Rent owed to:	Mortgage/Rent owed to:
Balance : (Mortgage only)	Balance : (Mortgage only)
Monthly Payment: Current APR %: (Mortgage only)	Monthly Payment: Current APR % : (Mortgage only)
Person Responsible for Payment:	Person Responsible for Payment:
INCOME	INCOME
Employer:	Employer:
Income: $ Net Gross Annual Monthly Bi-weekly Weekly	Income: $ Net Gross Annual Monthly Bi-weekly Weekly
Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.) Source: $ Annual Monthly Hourly	Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.) Source: $ Annual Monthly Hourly

By submitting this loan request, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment.

You authorize the credit union to obtain credit reports in connection with this request.

CSTLR1 6857 - Internet Loan Request

Your savings is federally insured up to $250,000 NCUA (National Credit Union Administration) a US government agency.
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