North Georgia Credit Union
PLEASE COMPLETE ALL SECTIONS. 
RED SELECTIONS ARE REQUIRED
(If a requried field does not apply to you type N/A)
LOAN APPLICATION - OVERDRAFT PROTECTION
DATE
 APPLICANT ACCOUNT NUMBER
Personal Collateral Secured Other
Amount Requested
$200.00
Purpose of Loan:
Overdraft
Collateral Offered      
Repayment: Payroll Deduction Automatic Transfer Cash
MARRIED APPLICANTS MAY APPLY FOR INDIVIDUAL ACCOUNTS. INDICATE BELOW THE TYPE OF CREDIT WANTED
INDIVIDUAL CREDIT: Complete Applicant Section. Complete other section if the following applies: You Live in a community property state (AZ, CA, ID, LA, NM, NV, P.R., TX, WA, WI) or your spouse will use the account - You are relying on your Spouse/Co-Applicant's income as a source of repayment.
APPLICANT
Complete for secured credit or if you live in a community property state
MARRIED SEPARATED UNMARRIED Single Divorced Widowed
FIRST
INITIAL
 		LAST NAME
SOCIAL SECURITY NO.
BIRTHDATE
HOME PHONE NO.
NO. OF DEPENDENTS AGE OF DEPENDENTS
    OWN   RENT   OTHER
CURRENT ST. ADDRESS
APT. NO     HOW LONG
CITY
STATE  
  ZIP
FORMER STREET ADDRESS  
CITY STATE      ZIP
E-MAIL ADDRESS
EMPLOYMENT AND INCOME 
CURRENT EMPLOYER
HIRE DATE
STREET ADDRESS
WORK PHONE NO.
CITY
STATE
    ZIP
POSITION
MONTHLY GROSS INCOME $
SUPERVISOR'S NAME   AND PHONE #
FORMER EMPLOYER-If less than 2 years with current employer must complete
START DATE END DATE
OTHER INCOME
You need not list income from alimony, child support or separate maintenance unless you wish it to considered for purposes of granting this credit.
SOURCE OF OTHER INCOME
 PHONE
 SINCE
 MONTHLY INCOME $
CO-APPLICANT
Complete for secured credit or if you live in a community property state
MARRIED SEPARATED UNMARRIED Single Divorced Widowed
FIRST
 INITIAL
 LAST NAME
SOCIAL SECURITY NO.   BIRTHDATE HOME PHONE NO.
NO. OF DEPENDENTS AGE OF DEPENDENTS
    OWN   RENT   OTHER
CURRENT STREET ADDRESS APT. NO      HOW LONG
CITY STATE      ZIP
FORMER ST. ADDRESS  
CITY STATE      ZIP
EMPLOYMENT AND INCOME 
CURRENT EMPLOYER HIRE DATE
STREET ADDRESS WORK PHONE NO.
CITY STATE ZIP
POSITION MONTHLY GROSS INCOME $
SUPERVISOR'S NAME   AND PHONE #
FORMER EMPLOYER-If less than 2 years with current employer must complete
START DATE END DATE
OTHER INCOME  
You need not list income from alimony, child support or separate maintenance unless you wish it to considered for purposes of granting this credit.
SOURCE OF OTHER INCOME
 PHONE
 SINCE
 MONTHLY INCOME $
PERSONAL REFERENCES INDICATE A = Applicant C = Co-Applicant
NEAREST RELATIVE NOT LIVING WITH YOU
A C NAME ADDRESS
PHONE RELATIONSHIP
PERSONAL FRIEND - NOT A RELATIVE
A C NAME ADDRESS
PHONE RELATIONSHIP
ASSETS
CHECKING SAVINGS
FINANCIAL INSTITUTION FINANCIAL INSTITUTION
APPROXIMATE BALANCE $ APPROXIMATE BALANCE $
CAR 1: YEAR/MAKE PLEDGED Y N CAR 2: YEAR/MAKE PLEDGED Y N

REAL ESTATE

 VALUE $
 OTHER
VALUE $
OUTSTANDING DEBTS AND OBLIGATIONS
Be sure to list all open accounts with a balance, include child support, alimony and IRS obligations, etc.
A = APPLICANT
C = CO-APPLICANT		      
INDICATE CODE
A or  C 		LIST ALL REGULAR MONTHLY DEBTS OWED BALANCE MONTHLY PAYMENTS

Please answer the following questions.
Please indicate A= Applicant C = Co-Applicant A
YES     NO 		C
YES     NO
1. Have you ever filed a petition for bankruptcy?
Date
2. Have you ever had an auto or furniture repossessed or property foreclosed upon?
Date
3. Are you a co-maker or co-signer of any loan or lease?
For whom?
Where ?
4. Do you have any past due bills?
5. Is any income you have listed likely to be reduced in the next two years?
6. Have you ever had credit in any other name?
What name?
7. Have you any suits pending, judgments filed, alimony or support awards against you?
8. Are you other than a U.S. Citizen or permanent resident alien?

By submitting this application to the Credit Union, I/we promise that everything is correct to the best of my/our knowledge and that the above information is a complete listing of my/our debts and obligations. I/we authorize the Credit Union to obtain credit reports in connection with this loan application and for any update or extension of the credit received. I/we understand that the Credit Union will rely on both the representations I/we make in this application and the contents of any credit report it obtains when deciding whether to grant the credit requested. I/we agree to immediately notify you of changes to any of the information provided in this application. I/we agree that my/our account will be subject to the terms and conditions of all applicable agreements and disclosures that will accompany the funds when issued; and that a photocopy or facsimile of this application shall be as binding as the original.

By submitting this application electronically, I/we agree to the same terms that apply to a signed application. If there is a co-applicant on this loan, that co-applicant has authorized the submission of this application. This electronic submission qualifies as my/our signature.


Note: Make sure all required fields are completed correctly.
Please click on the Submit button only one time.
The credit union will respond to your e-mail within one business day.
Please do not use e-mail to request transactions to your account.

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