Fillable Printable Credit Union Loan Application Sample Form
Fillable Printable Credit Union Loan Application Sample Form
Credit Union Loan Application Sample Form
This application must include all requested information. Please print this page and either mail the application to:
Texas DPS Credit Union
P.O. Box 15346
Austin, TX 78761
or FAX to the Loan Department: 1(512)467-1607
Please type in boxes or print clearly. Use a ball point pen for writing on and signing the application.
Amount of loan requested
$
I would like to sign up for Direct Deposit:
Yes No
I would like to set up Automatic Loan Payments:
Yes No
Type of Credit Requested:
INDIVIDUAL JOINT
Loan subject to credit approval.
Applicant's Credit Union Account Number
To Be Repaid In
Months
Purpose of Loan
Collateral Offered (unsecured, savings, vehicle, etc.)
As a Separate Loan Combined With My Loan Number:
#
Please supply verification of income with this completed application
Attach dealer's worksheet for automobiles or other item(s) being purchased that will be used to secure this loan.
APPLICANT / MEMBER INFORMATION
Name (Last, First & Middle)
Street Address
City State Zip
Home Phone # Cell/Other
Date of Birth Social Security #
Employer
Business Address
Occupation/TitleYears Employed There
State DL #
Gross Monthly Income Net Monthly Income
Other Monthly Income* Source of other income
Work Phone #
Texas DPS Credit Union Loan Application
OR
Rent or Mortgage Monthly Payment
email
FOR CREDIT UNION USE ONLY APPROVED DENIED DATE
CREDIT COMMITTEE/LOAN OFFICER
Credit Life Loan Protection?
Yes No
Are you a co-maker on any other loans?
Yes No
Have you ever filed for bankruptcy?
Yes No
JOINT APPLICANT (PLEASE COMPLETE IF YOU ARE APPLYING FOR JOINT CREDIT.)
Texas DPS CU Account #
Street Address
City State Zip
Date of Birth Social Security #
Employer
Business Address
Occupation/TitleYears Employed There
State DL #
Gross Monthly Income Net Monthly Income
Other Monthly Income* Source of other income
Work Phone #
Name (Last, First & Middle)
Rent or Mortgage Monthly Payment
Are you a co-maker on any other loans?
Have you ever filed for bankruptcy?
Yes No
Yes No
Complete this item if you live in a community property state (Arizona, California, Idaho, Louisiana, New Mexico,
Nevada, Texas, Washington, & Wisconsin).
Married Unmarried Separated
* Income from alimony, child support or separate maintenance income need not be revealed unless you wish such
income to support your request for credit.
By signing below, you acknowledge that you are giving the above information for the purpose of obtaining credit from Texas
DPS Credit Union, that everything you have stated in this application is correct to the best of your knowledge, and that you
understand that the credit union is relying on the statements you have made. Texas DPS Credit Union is authorized to check
your credit history, employment history, obtain a credit report and to answer questions about your credit experience with the
credit union. Additional information may be required. Caution: It is a crime to give false information or to force a document to
induce a credit union to grant a loan.
Applicant Signature
X Date: / /
Joint Applicant Signature (If Applicable)
X Date: / /
Credit Application Page 2 of 2
IF REJECTED, REASON
Applicant / Member Information (continued)
Home Phone # Cell/Other email
