ROSE CITY FEDERAL CREDIT UNION

P.O. Box 2741, Thomasville, GA 31799
Office 229-228-9826 / Lending Center 229-584-1082 / Toll Free 866-389-7673 / Fax to 229-226-2171
APPLICATION FOR LOAN
(This application should be hand delivered, mailed or faxed to the credit union)

Member # sub # Joint application? (Check if Yes)
(Co-applicant must complete separate application)
Name: SS#
Address: City: State: Zip:
Home Phone: Work Phone: Birthdate: mm/dd/yyyy
Purpose of Loan:

( Check one ) Refinance ? New Loan ? Payroll ? Manual Payments ? Sharedraft ?
Dollar Amount Requested:
Employer: Title:
Hire Date: Mo. Income: Other Income:
Source:
Previous Employment:
Name and address of nearest relative:
Relationship: Home Phone: Work Phone:
Collateral description:

DEBTS
I am indebted to the following creditors: Please list all secured and unsecured debts.
Individual
or Joint
Creditor Name: Orig Loan Amount Balance Owed Payment Amount Pastdue? Check if yes

List any other names you have gained credit under:

Are you a co-maker or guarantor on any other loan?
(Check if yes) For who:
Do you have any Judgements, Garnishments, or Legal Proceedings against you?
(Check if yes) If yes, Where?
Have you ever filed Bankruptcy?
(Check if yes) Type: Year:

I hereby certify that all statements made are true and complete and submitted for the purpose of obtaining credit. I have no other debts. The credit union is authorized to check my credit and employment history and to answer questions about its credit experience with me.
Authorized Signature: Date:
( Pringing Instructions: Portrait, all borders = 0.5" )


FOR CREDIT UNION USE ONLY:

Date: Approved Limits Unsecured $ Line of credit $
Other Secured $ Debt Ratio:
Advance Approved: Yes No Loan Officer: #
Committee: Yes No Counter Officer:
If accepted, advance approved.
1. 2.
3. 4.
Outside information considered: Yes No If Yes, attach additional sheet and describe
Specific Reason for Rejection:


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