Secure Loan Application

GREAT MEADOWS AUTO SALES
Secure Loan Application

Primary Borrower Information

Applicant Information

Name(Last - First - Initial):

Mother's Maiden Name:

Account Number:

Social Security Number:

- -

Drivers License Number / State:

Date of Birth:

/ /

Home Phone:

Business Phone:

Email Address:

Current Address (Street Address - City - State - Zip):

Rent / Own or other:

Rent Own Other

Years at this Address (years/months)

Mortgage/Rent Owed to:

Mortgage Balance:

Monthly Payment:

Interest Rate %:

Complete for Joint Credit, Secured Credit or If you live in a Community Property State:

Married Separated Unmarried (Single - Divorced - Widowed)

Employment

Employer Name:

Employer Address:

Start Date:

/ /

Notice: Alimony Child Support or Separate Maintenance Income need not to be revealed if you do not choose to have it consider:

Employment Income:

$ PER

Other Income:

$ PER

Net or Gross:

NET GROSS

Other Income Source:

References

Name and Address of Nearest Relative not living with you:

Relationship:

Phone Number:

State Law Notices

Ohio Residents Only:

The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

Wisconsin Residents Only:

SIGN FOR WISCONSIN RESIDENTS ONLY (1) No provision of any marital property agreement, unilateral statement under $ 766.59 or court decree under $ 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement statement or decree or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of marriage or family of the undersigned.

Date:

Signature Line Date:

Consent:

1. You Promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension, or collection of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or Incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA. 2. You have received and read the LOANLINER Credit and Security Agreement including the Addendum (Agreement) and Borrower Copy of the LoanLiner Credit / Security Agreement PLUS and Voluntary Payment Protection. By Signing below you agree to be bound by the terms of the Agreement. 3. You grant us a security interest in all individual and joint share and / or deposit accounts you have with us now and in the future to secure what you owe under the LOANLINER Credit and Security Agreement. When you are in default, you authorize us to apply the balance in these accounts to any amounts due. Shares and deposits in and Individual Retirement Account, and any other account that would lose special tax treatment under state or federal law if given as security, are not subject to the security interest you have given in your shares and deposits.

Applicant Signature:

(Add your Initials please)

Date:

Other Signature:

(Add your Initials please)

Date:

Enrollment /Application and Schedule for Voluntary Payment Protection

CUNA Mutual Insurance Society - Madison - WI - 53701-0391 - Phone 800/937-2644

Enrollment :

Yes NoYou or Your means the member and the joint insured (if applicable). The joint insured is eligible only for life coverage. - Credit life and credit disability insurance is voluntary and not required in order to obtain this loan. You may select any insurer of your choice. You can get this insurance only if you check -yes- for the coverage desired , sign your name and write in the date. The rate you are charged for the the insurance is subject to change. You will receive advance written notice before any increase goes into effect. You have the right to stop this insurance by notifying your credit union in writing. If you elect Insurance the credit union to add the charges for insurance to your loan each month. You are eligible for credit disability insurance only if you are actively at work a minimum of 25 hours a week. On this date, are you presently actively at work and regularly performing all of the usual duties of a gainful occupation a minimum of 25 hours a week. If you are off work because of temporary layoff , strike or vacation , but soon to resume , you will be considered at work. You are eligible for insurance up to Maximu Age for Insurance. Insurance will stop when you reach that age. Note. The Life and disability insurance contains certain benefit exclusions including a pre-existing condition exclusion (for credit disability insurance). Please refer to your certificate for details.

You elect the Following Insurance Coverage (Single Credit Disability):

Yes No

You elect the Following Insurance Coverage (Single Credit Life):

Yes NoCost per $100 of your monthly loan balance - $.062

You elect the Following Insurance Coverage (Single Credit Life):

Yes NoCost per $100 of your monthly loan balance - $.09

Covered Member:

(please print)

If you are totally disabled for more than 14 days , then the disability benefit will begin with the 1 st day of disability.

Account Number:

Group Policy Number:

029-0869-2

Date of Issue of this certificate:

/ /

Secondary Beneficiary (if you design one)

Date:

Member Date of Birth:

/ /

Signature of Member:

Signature of Joint Insured (Co-Borrower):

Only Required if Joint Credit Life Coverage is selected

Co-borrower Information

Applicant Information

Name(Last - First - Initial):

Mother's Maiden Name:

Account Number:

Social Security Number:

- -

Drivers License Number / State:

Date of Birth:

/ /

Home Phone:

Business Phone:

Email Address:

Current Address (Street Address - City - State - Zip):

Rent / Own or other:

Rent Own Other

Years at this Address (years/months)

Mortgage/Rent Owed to:

Mortgage Balance:

Monthly Payment:

Interest Rate %:

Complete for Joint Credit, Secured Credit or If you live in a Community Property State:

Married Separated Unmarried (Single - Divorced - Widowed)

Employment

Employer Name:

Employer Address:

Start Date:

/ /

Notice: Alimony Child Support or Separate Maintenance Income need not to be revealed if you do not choose to have it consider:

Employment Income:

$ PER

Other Income:

$ PER

Net or Gross:

NET GROSS

Other Income Source:

References

Name and Address of Nearest Relative not living with you:

Relationship:

Phone Number:

State Law Notices

Ohio Residents Only:

Wisconsin Residents Only:

Date:

Signature Line Date:

Consent:

Applicant Signature:

(Add your Initials please)

Date:

Other Signature:

(Add your Initials please)

Date:

Enrollment /Application and Schedule for Voluntary Payment Protection

CUNA Mutual Insurance Society - Madison - WI - 53701-0391 - Phone 800/937-2644

Enrollment :

You elect the Following Insurance Coverage (Single Credit Disability):

Yes No

You elect the Following Insurance Coverage (Single Credit Life):

Yes NoCost per $100 of your monthly loan balance - $.062

You elect the Following Insurance Coverage (Single Credit Life):

Yes NoCost per $100 of your monthly loan balance - $.09

Covered Member:

(please print)

If you are totally disabled for more than 14 days , then the disability benefit will begin with the 1 st day of disability.

Account Number:

Group Policy Number:

029-0869-2

Date of Issue of this certificate:

/ /

Secondary Beneficiary (if you design one)

Date:

Member Date of Birth:

/ /

Signature of Member:

Signature of Joint Insured (Co-Borrower):

Only Required if Joint Credit Life Coverage is selected

By submitting this application, I certify that all information herein is true and complete. I agree I am providing this information to the dealer identified in this application and acknowledge that my information may be shared pursuant to the dealer’s privacy policy, if applicable. I hereby authorize this dealer, and any financial institution engaged as a service provider by this dealer, to retain this application and to check and verify my credit, employment and salary history. By submitting this application, I acknowledge I am authorizing this dealer to check my credit.

GREAT MEADOWS AUTO SALESSecure Loan Application

Primary Borrower Information

Applicant Information

Employment

References

State Law Notices

Signature Line Date:

Enrollment /Application and Schedule for Voluntary Payment Protection

Co-borrower Information

Applicant Information

Employment

References

State Law Notices

Signature Line Date:

Enrollment /Application and Schedule for Voluntary Payment Protection

GREAT MEADOWS AUTO SALES
Secure Loan Application