Riverside Community FCU
101 N. Washington Street, Marion, IN 46952
Phone:765-662-3969, Fax:
General Information: ( Required fileds are marked with an *) - This application is NOT used for Mortgages, HELOC, and Credit Cards. Please contact the credit union for further details.
Will there be a co-applicant on this application? Yes No
(If Yes, the co-applicant section has the same required fields as the primary applicant.)
*Type of Loan:    
*Loan Amount:   $ *Loan Term:
(If requesting a vehicle loan, provide the following information about the vehicle.)
Year(####)
Make
Model
VIN
Mileage
Applicant Information:
*Member Number: Enter NONE if you are NOT a credit union member.
*First Middle Last Name:
*SSN: - - * DOB: / /
Marital Status: Complete marital status if this loan is for: Joint or secured credit, or you reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)
Unmarried Married Separated
This application is not for joint or secured credit and I do not live in the states listed above.
Applicant Home Address:
*Address 1:
Address 2:
*City, State, Zip: , , -
Time at Current Residence: Years Months Type: Own Rent Other
Monthly Payment: $
*Main Contact Number:
 - - Email Address:
Number:
- - ext:  
Work Phone Number: - - ext:  
Mother's Maiden Name:    
Number of Dependents:
Ages:
Drivers License #: DL State:
 
Applicant Present Employer:
Name Job Title
Employment Status: Full Time Part Time Temp Retired Other
Phone Number - - ext.:  
       
Job Start Date: / / Gross Salary: $ Per
Other Income Source: Other Income: $ Per
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
       
 
Applicant Nearest Relative not living with you:
First & Last Name:
Phone: Relationship:
Address1:
Address2:
*City, State, Zip: , ,
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Applicant Debts / Monthly Payments:
List all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support, child care, medical utilities, auto insurance, IRS liabilities, etc.) Please use a separate line for each credit card and auto loan.
Debts Monthly Payments
Credit Card $
$
$
$
$
$
$
$
$
$
$

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Co-Applicant: Complete this section ONLY if applying for a joint loan. I/WE UNDERSTAND THAT BY COMPLETING THE CO-APPLICANT INFORMATION THAT THE CREDIT UNION MAY NOTIFY ME AND THE COAPPLICANT IN WRITING OR BY TELEPHONE TO VERIFY THEIR WISHES TO BE CO-APPLICANT AND THAT I/WE FULLY UNDERSTAND THIS APPLICATION IS FOR JOINT CREDIT. 
*First Middle Last Name
*Member Number (if not a member put: NONE)
*Social Security Number (TIN) - - DOB: / /
CoApplicant Home Address:
Address 1:
Address 2:
City, State, Zip: , , -
Time at Current Residence: Years Months Type: Own Rent Other
Monthly Payment: $
Main Contact Number: - - Email Address:
Work Phone Number: - - ext.:  
Number: - - ext.:  
    Mother's Maiden Name:
Number of Dependents: Ages:
Drivers License #: DL State:
       
 
CoApplicant Present Employer:
Name: Job Title:
Employment Status: Full Time Part Time Temp Retired Other
Phone Number: - - ext.:  
Job Start Date: / / Gross Salary: $ Per
Other Income Source: Other Income: $ Per
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
       

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Additional Information:
How would you prefer to be contacted?
Home Phone Work Phone Cell Phone Email Address
Other
Special Instructions/Comments/ Reason for the Loan.
Income verification is required. Other information may be required. Loan Approval and Interest Rate is determined by your credit history. I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Credit Union, information concerning me or my affairs. (Sec. 1014, Title 13, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.)

This form is being submitted from IP Address: 216.73.216.61