Consumer Loan / Credit Card Application


* Required Fields

Loan Information *

Type of Application

Marital Status
New Auto Loan Used Auto Loan
Personal Loan Share Secure Loan
Credit Card RV/Motorcycle Loan
Loan Request Amount *
$ for months
Dealer Purchase Lease Buyout
Private Purchase Refinance
 
New Used
 
Year Mileage
Make Model
Insurance Co.
Phone
Individual credit
Joint credit with spouse
Joint credit with

who is not your spouse and must
complete a separate application.
Married
  (you may apply for separate or joint credit)
Separated
Unmarried
  (includes single, divorced, and widowed)

List the number of people dependent on you
for financial support:

Applicant Information
How Did You Hear About Us? *
Name *
 Social Security Number *
 DOB *
 Driver's License
 State
 Email
Home Phone *
 Cell Phone
 Live with: Own
Rent 		Parents
Other 		Name & Phone of friend/relative not living with you
Street Address *
 City
 Country
 State
 Zip
 Time At Present Address
Yrs: Mos:
Previous Street Address (if less than 2 years current)
 City
 Country
 State
 Zip
 Time At Previous Address
Yrs: Mos:
Employer's Name
 Address
 City
 Type of Business
Position/Title
 Work E-mail
 Work Phone
 Time There
Yrs: Mos:
Gross Monthly Income *


Income verification is required in order to process this loan. Please forward either your most recent paystub or a copy of your tax returns to: info@luso-american.com.
Do you intend to rely on spouse's
earnings to qualify for this loan?		 Yes  No
If yes, your spouse will be required to sign the promissory note and complete the Spouse Information section below
Other Income
$per month		 Source
Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification.
Previous Employer (if less than 3 years at current)
Address
 Phone
 Position
 Time There
Yrs: Mos:

Spouse Information (Complete only if spouse is applying)
Name
 Social Security Number
 Date of Birth
 Driver's License
 State
 Email
Gross Monthly Income
Do you intend to rely on spouse's
earnings to qualify for this loan?		 Yes  No
If yes, your spouse also may be required to sign the promissory note
Other Income
$per month		 Source
Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification.
Employer's Name
 Address
 City
 Type of Business
Position/Title
 E-mail
 Work Phone
 Time There
Yrs: Mos:
Previous Employer (if less than 3 years at current)
Address
 Phone
 Position
 Time There
Yrs: Mos:

Bank References
Name
 Branch/Address
 Checking Acc't No.
 Savings Acc't No
Name
 Branch/Address
 Checking Acc't No.
 Savings Acc't No

Home Information
* Rent Own First Mortgage Holder or Landlord
 Address
Purchase Date/House
 Purchase Price
 Estimated Current Value
 Balance Owing
 Mortgage No.
 Monthly Payment/Rent *

Credit Reference
List all debts, including second mortgage. Provide additional documentation if needed.
Name of Lender
 Address
 Account No.
 Original Amount
 Balance
 Mo. Payment

 
Auto Loan (Open or Closed)

Have you or your Spouse ever:
Declared Bankruptcy? Yes No
Had a Judgment? Yes No
Had a repossession or foreclosure? Yes No
If yes to any of the above, please explain below

Automatic Loan Payment
Do you want your monthly payment automatically deducted from your Fiserv checking or savings account?
Yes, Account # No
Automatically transferred funds will be applied as my monthly payment on each monthly due date so long as there are adequate funds on deposit or there is available credit in my account, until the loan is paid or the Bank receives written notice to cancel. I understand the Bank reserves the right to terminate the automatic repayment plan without notice.
Please initial your request:

Agreement/Signature
I certify that all information provided by me is true, correct and complete. I authorize Luso American Credit Union to make whatever inquires about me you deem necessary and appropriate for the purposes of evaluating my credit application. including credit reports and contacting my employer. I also authorize Luso American Credit Union to provide credit information about its credit experience with me to other creditors and credit reporting agencies.
X: X:
  Applicant Signature Date Spouse Signature
(Spouse should sign only if applying for joint credit)		 Date