LoanPage

Your Original Jefferson County Credit Union, Since 1939

ON-LINE LOAN APPLICATION

Welcome to QuimperFCU's on-line loan application.
This application is to be used for consumer loans and VISA Credit Cards only.

You may expect a response to your loan application within 24 hours, or no
more than 2 business days from the time of submission. If there has been no
response after the 2nd business please call and speak to one of our loan
officers at 385-3663 or 1-800-505-3347.

Loan Request Information
Are you a currently a Member? Yes No Amount of Loan: Purpose of Loan: Visa Card	Method of Repayment: Cash/Check Payroll Deduction

Loan Request Information
Are you a currently a Member? Yes No Amount of Loan: Purpose of Loan: Visa Card	Method of Repayment: Cash/Check Payroll Deduction

Type Of Account Requested
Individual Credit: Complete only "Applicant" Section if you are requesting individual credit and not relying on the income or assets of another person as a basis for repayment of the credit requested. Also complete "Other Applicant" section (1) with spousal information if you live in a community property state (AZ, CA, ID, LA, NV, NM, TX, WA, WI); (2) with information about the person whose alimony, support, maintenance payments, or income upon which you are relying as a basis for repayment of the credit requested.
Joint Credit: Complete both "Applicant" and "Other Applicant" sections if you are applying for joint credit or for an account you and another person will use.
Guarantors: Complete only the "Other Applicant" section with information about a Guarantor applicant.

Tell Us About Yourself

Applicant

Other Applicant

Name:

CU Account#:

Social Security#:

Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:
Married Separated

Unmarried
Total Dependents(Exclude Self):

Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:
Married Separated

Unmarried
Total Dependents(Exclude Self):

Driver's License#: State:

Date of Birth:

Home Telephone:
Work Telephone:
Email Address:

Present Street Address (do not list PO Box):

CityState	Zip Code

Years There: Own Rent

Mortgage Company or Landlord	Payment

Present Street Address (do not list PO Box):

CityState	Zip Code

Years There: Own Rent

Mortgage Company or Landlord	Payment

Income

Current Employer:

Date Employed Gross Income	Frequency
	Annual Monthly Hourly
Hours Worked per week

Current Employer:

Date Employed Gross Income	Frequency
	Annual Monthly Hourly
Hours Worked per week

Previous Employer:

Date Employed Gross Income	Frequency
	Annual Monthly Hourly

Previous Employer:

Date Employed Gross Income	Frequency
	Annual Monthly Hourly

Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)
Source: Amount:
Annual Monthly Hourly

Have you ever obtained credit under another name?	Yes No
Are you a co-signer on any other loan?	Yes No
Have you ever filed bankruptcy or had a repossession?	Yes No
Are there any judgements or liens against you?	Yes No

Visa Card Credit Card Disclosures

Disclosure Table for Quimper Community Credit Union Credit Cards*
Annual percentage rate for purchases	13.90%
Variable-rate information	N/A
Grace period for repayment of the balance for purchases	25 Days
Method of computing the balance for purchases	Average Daily Balance
Annual fees - Unless balance transfer of $1,000 or more	$0.00
Minimum finance charge	$.50
Transaction fee for purchases	0.00
Transaction fee for cash advances	$.50
Late-payment fee	$10.00
Over-the-credit-limit fee	$10.00 per billing cycle
Note: * Above Visa Card Disclosures subject to change.

Would you prefer the loan being serviced in the Port Hadlock or Port Townsend building?

Hadlock

Townsend

Special Instructions:

By submitting this loan request, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment. You authorize the credit union to obtain credit reports in connection with this request.

There is a $10 per person credit report fee which is paid out of approved loans.
To apply you must be a member of the credit union. If you are not a member,
you may download a New Member Application Here.

Before processing can be completed on your loan we may request information and amounts on your current debts and assets, we may request this by e-mail or phone. In some instances we are also required to receive your last two paystubs and tax returns or other information before we can approve your loan. You may also print an application, which you can deliver by hand, fax or mail. Thank You!

If you are applying for a Home Equity Line of Credit please read or print
the brochure at this link:

http://www.federalreserve.gov/pubs/homeline/

Savings Federally insured to at least $100,000 by NCUA, an Agency of the U.S. Government.

Disclosures

We do business in accordance with the Federal Fair Housing Law and the Equal Credit Opportunity Act.