Print out, fill in information and fax to (310) 328-3507
Date ___________ ACCT#___________ Loan No. ___________	Information contained in this application is restricted to persons with the need to know. But all information while confidential, is subject to verification

USEIT Credit Union
2409 Arlington Avenue Torrance, CA 90501

Loan Application

Please attach check stub for salary and employment verification

Amount and purpose:
Amount applied for New Loan $___________________________
Old Loan Balance $___________________________ Total Loan $___________________________

For The Following Purpose ____________________________________________________

For a period of ____________months, to be repaid in __________________ monthly payments
of ____________________ first payment to be made ___________________________

Name________________________________   SSN _______________   Birthdate ______________ Age_____
Present Address (street)_____________________________________________ How long? __________
City________________________ State ______________ Zip ___________
Previous Address (street)_____________________________________________ How long? __________
City________________________ State ______________ Zip ___________
Drivers License No.____________________________Home Phone #____________________
Marital Status: oMarried    oUnmarried      oSeparated              No. of Dependents_________________
List ages of dependents ___________________________________________________________________
Employer __________________________________     Job title __________________________________
Phone _______________________    Hire date__________________ Monthly Salary $_________________
Employers Address ______________________________________________________________
Supervisor _____________________________        Phone #_________________
Previous Employer __________________________________
Supervisor _____________________________        Phone #_________________
*Name of Spouse_____________________________ *SSN __________________________
*Drivers License No.________________________   *Birthdate ______________    *Age_____
*Spouse's Employer ________________________   *Employers Address ________________________________
*Monthly Salary $_________________
Source of other income, if any. Alimony, spousal support, child support, or separate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
$______________________________________________
Applicant's and spouse's total income $__________________________________

Bank and Savings & Loan	Account at	Branch Address	Type of account
Bank and Savings & Loan	Account at	Branch Address	Type of account
Real Estate	To whom indebted	Address	Monthly payment
	Date Purchased	Purchase Price $_________________	Balance Owing $__________________
	Second deed holder	Address	Balance Owing $__________________
Rent	oFurnished oUnfurnished	Monthly rent $________________________________________
Autos	Make______ Year_______ Model________________	Financed by _______________	Present balance $__________________
Autos	Make______ Year_______ Model________________	Financed by _______________	Present balance $__________________

OUTSTANDING DEBTS AND OBLIGATIONS - List all debts such as doctor bills, installments, loans, etc. If no current open accounts, list two paid accounts. List monthly child support payment. If spouse has any credit union loans or other obligations, please list. Attach Separate Sheet If Necessary

Name and Address	Present Balance	Monthly Payment






TOTALS	$	$

Has you or your spouse ever been sued for debts? oYes oNo Filed for bankruptcy? oYes oNo
Filed Chapter XIII? oYes oNo

Are you and/or your spouse co-makers, endorsers, or guarantors on a loan? oYes oNo
For whom?____________________________ Where?__________________ How much? $_________________________

References
	Name	Complete Address	Telephone
Your Parents
Spouse's Parents
Other relative not residing with you
Friend
Friend

The undersigned hereby certifies that all information given on this application is true and correct, and is given for the purpose of inducing the above named credit union to extend a loan to me, and further certifies that there is no outstanding indebtedness to any other credit union, finance or loan company, either as maker, co-maker, or endorser and that I have no other debts, bills, installments or other payments other than as stated on this application.

* Information concerning spouse need not be stated if applying separately and loan is to be repaid with separate income or property as listed if the applicant is not a resident of California or any other community property state.

_____________________________________________________________
* Signature of Spouse

_____________________________________________________________
Signature of Applicant

________________
Date