Central Vermont Medical Center, Inc. Credit Union

 

 Universal Loan Application

You must be a member of this Credit Union to apply for a loan. If you are not currently a member please complete and send an Application for Membership, paying particular attention to the eligibility for membership requirements. Applicants are required to provide all the applicable information prior to sending the loan application to the Credit Union, an incomplete application will delay processing. Please understand by completing and sending this application you are giving the Credit Union authorization to evaluate your creditworthiness (see authorization notice below). If we decide to approve your request for a loan then you, and the co-applicant if applicable, will be required to come to the Credit Union to complete the application process and sign appropriate loan agreements. You may call us and ask about the status of your application.

Amount Requested:
Payment Frequency
Loan Purpose:
Collateral:
Account Number:

Applicant
Last Name: Initial:
First Name:
Mother’s Maiden Name:
Social Security Number: – –
Driver’s License: State:
Date of Birth: MM/DD/YYYY
Home Phone: – –
Work Phone: – –
Street:
City:
State: Zip:
Do you Own or Rent?:
Years at this address:
Email Address:
Employer:
Employer Address:
Employment Income $: Per:
Employer Start Date: MM/DD/YYYY
Alimony, child support, and separate maintenance income need not be revealed if you do not wish to have it considered.
Other Income: Monthly Amount Source
Other Income #1:
Other Income #2:

Other Applicant (if applicable)
 
Last Name: Initial:
First Name:
Mother’s Maiden Name:
Social Security Number: – –
Driver’s License: State:
Date of Birth: MM/DD/YYYY
Home Phone: – –
Work Phone: – –
Street:
City:
State: Zip:
Do you Own or Rent?:
Years at this address:
Email Address:
Employer:
Employer Address:
Employment Income $: Per:
Employer Start Date: MM/DD/YYYY
Alimony, child support, and separate maintenance income need not be revealed if you do not wish to have it considered.
Other Income: Monthly Amount Source
Other Income #1:
Other Income #2:
Authorization Notice: By submitting this application to the Credit Union, you certify that everything you have stated in this application is correct to the best of your knowledge, and you have read the eligibility requirements for the Credit Union. You understand that the Credit Union will rely on the representations you make in this application when deciding whether to grant membership. You agree to immediately notify us of changes to any of the information you have provided in this application. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on applications made to Credit Unions or State Chartered Credit Unions insured by NCUA.  download this form