Loan Application Bethlehem 1st Federal Credit Union Loan Application Step 1 of 7 - Tell Us About the Loan You Want 0% Step 1: Tell Us About the LoanType of Loan I am Applying for: (Choose one)*New VehicleUsed VehicleHome Equity LoanHome Equity Line of CreditUnsecured Personal (Signature)Pledged Share Loan (Secured)Technology LoanOther (Please specify)(If you chose "Other" for type of loan, explain here:)The purpose of the loan is:This is how much I want to borrow ($):*Length of Repayment (Years)*Method of Payment: (Choose one)*Automatic transfer from checkingAutomatic transfer from savingsPayroll deductionCouponsCo-Signer?*No, I will not have a co-signer on this loanYes, I will have a co-signer on this loan.Depending on your situation, you may need to have someone co-sign this loan. Step 2: Insurance CoveragePurchase Credit Life Insurance? (Choose one)*Yes, I want Credit Life Insurance for meYes, I want Credit Life Insurance for my co-applicant and meNo, I do not want Credit Life InsurancePurchase Credit Disability Insurance? (Choose one)*Yes, I want Credit Disability Insurance for meYes, I want Credit Disability Insurance for both my co-applicant and meNo, I do not want Credit Disability Insurance Step 3: Tell Us About YourselfMy Email Address:* Enter Email Confirm Email My Name:* First Name Middle Name Last Name Jr., Sr., etc. My Social Security Number:*My Bethlehem 1st Federal Credit Union Account Number:*If you are not currently a member, please enter "Not a member yet".Driver's License Number:Driver's License State: (PA, NJ, etc.)My Birth Date:* Date Format: MM slash DD slash YYYY My Marital Status****Not specifiedMarriedSeparatedUnmarried (Single, Divorced, Widowed)****If you are applying for joint credit, secured credit, or if you live in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI, Puerto Rico), please provide a marital status.My Home Phone:Leave blank if you do not have a home phone.My Cell Phone:My Current Address:* Street Address Address Line 2 (Optional) City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State (PA, NJ, etc.) ZIP Code About My Current Address (Select One)*I own my homeI rent my homeOtherI have lived at this address for this many years:*Please enter a number from 0 to 100.My Previous Address* Street Address Address Line 2 (Optional) City State (PA, NJ, etc.) ZIP Code *Only fill this out if you have lived at your current address for less than 3 years. Step 4: Your Employment & Other IncomeTo expedite the processing of this loan application, please fax two recent paystub copies to (610) 691-8624, Attention: Loan Department. If you are self-employed or retired, Federal income tax returns will be needed.My Current Employer (Company Name):My Employer's Phone Number:My Job Title:My Gross Monthly Income ($)Hours I work each week:I have been employed at my current employer for this many years:Please enter a number from 0 to 80.My Previous Employer:****Only needed if you have been employed by your current employer for less than 2 years.To expedite the processing of this loan application, please fax two recent paystub copies to (610) 691-8624, Attention: Loan Department. If you are self-employed or retired, Federal income tax returns will be needed.Other Monthly Income**Please enter a number from 0 to 500000.**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.Source of that Other Monthly Income Step 5: Your Credit InformationMy Monthly Rent or Mortgage Payment ($)Please enter a number from 0 to 100000.If you rent or own a home, enter the dollar amount you pay each month.Companies and People I Owe Money To**This is who I owe money toThis is how much I pay them monthly ($)This is my current balance ($) **Click the + sign to add another creditor. Co-Signer Personal Information If you will have someone co-signing for this loan, put their information in this and the next two pages.Co-Signer's Name* First Name Middle Name Last Name Jr., Sr., etc. Co-Signer's Email Address: Co-Signer's Social Security Number:*Co-Signer's Birth Date* Date Format: MM slash DD slash YYYY Co-Signer's Bethlehem 1st Federal Credit Union Account Number:*If Co-Signer is not currently a member, please enter "Not a member".Co-Signer's Driver's License Number:Cosigner's Driver's License State: (PA, NJ, etc.)Co-Signer's Marital Status:***Not SpecifiedMarriedSeparatedUnmarried (Single, Divorced, Widowed)***If you are applying for joint credit, cecured credit, or if you live in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI, Puerto Rico), please provide a marital status.Co-Signer's Home Phone:Leave blank if you do not have a home phone.Co-Signer's Cell Phone:Co-Signer's Address:* Street Address Address Line 2 (Optional) City State (PA, NJ, etc.) ZIP / Postal Code About Co-Signer's Current Address (Select One)*I own my homeI rent my homeOtherCo-Signer has lived at this address for this many years:*Please enter a number from 0 to 80.Co-Signer's Previous Address** Street Address Address Line 2 (Optional) City State (PA, NJ, etc.) ZIP Code **Only supply your previous address if you have been at your current address less than 3 years.Step 7: Co-Signer's Employment & Other IncomeCo-Signer's Current Employer (Company Name):Co-Signer's Employer's Phone Number:Co-Signer's Job Title:Co-Signer's Gross Monthly Income ($)Hours Co-Signer works each week:Number of Years at this Employer:Please enter a number from 0 to 60.Co-Signer's Previous Employer:****Only needed if you have been employed by your current employer for less than 2 years.Co-Signer's Other Monthly Income: ($)****NOTE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for this credit request.Source of Co-Signer's Other Monthly IncomeTo expedite the processing of this loan application, scan two recent pay stubs to loans@beth1st.org. You may also fax the pay stubs to (610) 691-8624, Attention: Loan Department or drop them off at the Credit Union. If you are self-employed or retired, Federal income tax returns will be needed instead of the pay stubs.Step 8: Co-Signer Employment Credit InformationCo-Signer's Monthly Rent or Mortgage PaymentIf you rent or own a home, enter the dollar amount you pay each month.Co-Signer's Credit Information**This is who I owe money toThis is how much I pay them monthly ($)This is my current balance. ($) **Click the + sign to add another creditor. You've completed your Loan Application! By clicking the SUBMIT button below, you indicate that you agree with the following: You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. 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 crime to willfully and deliberately provide incomplete or incorrect information in this application. NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
