Kenmore Teachers FCU

Applicant Name

First NameMiddle InititalLast NameSuffix

Applicant Cell Phone

Please enter a valid phone number.Format: (000) 000-0000.

Applicant Email

Applicant Date Of Birth

Applicant SSN

Applicant Driver's License Number

State License Issued

Applicant Home Phone

Please enter a valid phone number.Format: (000) 000-0000.

Marital Status

# of Dependents

Home Type

If Other Home Type, please explain.

Do you rent or own your home?

If you neither Rent nor Own your home, please explain.

Applicant Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Number of Years at Current Address?

Prior Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Select the type of Application?

Note, if this is a Joint Application, the Joint Applicant must submit a separate application.

Select your role as the applicant?

Enter Name of the Co-Borrower or Co-Signer.

First NameMiddle InitialLast NameSuffix

Enter Email of the Co-Borrower or Co-Signer.

example@example.com

What Credit Limit are you requesting?

Payment Method

If Other, please explain.

Payment Frequency

If Other, please explain.

Share or Share/Draft Account Number

If this loan request relates to an existing account, enter the Share or Share Draft account number.

How many Cards are you requesting?

The number of Cards requested should equal the sum of Applicant cards plus Additional Authorized users.

Select which Applicants receive a card.

#1 Additional Authorized User (if any).

First NameLast NameSuffix

#1 Add'l Authorized User Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

#1 Add'l Authorized User SSN

#1 Add'l Authorized User Date of Birth

Date

#2 Additional Authorized User (if any).

First NameLast NameSuffix

#2 Add'l Authorized User Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

#2 Add'l Authorized User SSN

#2 Add'l Authorized User Date of Birth

Date

#3 Additional Authorized User (if any).

First NameLast NameSuffix

#3 Add'l Authorized User Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

#3 Add'l Authorized User SSN

#3 Add'l Authorized User Date of Birth

Date

Reference 1 Full Name

Address

Phone

Please enter a valid phone number.Format: (000) 000-0000.

Relationship

Reference 2 Full Name

Address

Phone

Please enter a valid phone number.Format: (000) 000-0000.

Relationship

Employment Status

If Employment Other, please explain.

Monthly Gross Income

Company Name

Employer Phone

Please enter a valid phone number.Format: (000) 000-0000.

Position

Hire Date

Date

Employment Type

Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Separation End Date

Date

If Military, Is your separation date within a year

Previous Employer

Hire Date

Who owns your home?

Estimated Value of the Property

Other Income 1

Source of IncomeFrequencyMonthly Income

Other Income 2

Source of IncomeFrequencyMonthly Income

Other Income 3

Source of IncomeFrequencyMonthly Income

Other Income 4

Source of IncomeFrequencyMonthly Income

Other Income 5

Source of IncomeFrequencyMonthly Income

Do you have a mortgage, lease or pay rent?

Enter Housing Cost or Debt Information.

Creditor NameCurrent BalanceMonthly PaymentInterest Rate (%)

Other Debt 1