Please select the branch you would like to disburse your loan at. For an out-of-state loan select the “Loans By Phone” department.

Type in your responses below and then print the screen and mail or fax it to NFCU. Our mailing address is PO Box 15400, Las Vegas, Nevada 89114. The fax number is indicated above.

Vehicle Loan of $
Type: New Used from dealer Used from private party Other
Signature Loan of $ Purpose:
Share/Certificate secured of $ Account or Certificate Number:
Line of Credit with limit of $
Visa Classic $ Visa Gold (Regular) $ Visa Gold (Wings) $
Visa (Secured) $
2nd Trust Deed – fixed rate $
Home Equity Line of Credit $

TYPE OF ACCOUNT: Individual Credit or Joint Credit with: Spouse Other Co-Applicant

PAYMENT PROTECTION COVERAGE (optional)
Select the coverage(s) desired. The credit union will disclose the cost of this Payment Protection Coverage to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.

Do you want your loan protected for you and your family if you become disabled? Yes No

Do you want your loan protected for you and your family in the event of your death? Yes No

Married Applicants May Apply for individual credit. Complete the spousal information if you are a resident of a community property state (CA, AZ, ID, NV, LA, WA, NM, WI, TX) or if you are relying on income or property from a community property state, or if you are applying for joint credit with your spouse.

Income from alimony/child or spousal support/separate maintenance payments need not be revealed unless you wish the credit union to consider them as a basis for repayment of debt.

MEMBER: Married Unmarried Separated
NAME: NFCU ACCOUNT #:
SOCIAL SECURITY #: DATE OF BIRTH:
DR. LIC. #: STATE: DEPENDENTS’ AGES:
E-MAIL ADDRESS:
ADDRESS:
CITY: STATE: ZIP:
HOME PHONE: HOW LONG:
PREVIOUS ADDRESS:
EMPLOYER: HOW LONG:
POSITION:  
EMPLOYER’S ADDRESS:
CITY: STATE: ZIP:
WORK PHONE: MONTHLY GROSS: $
SOURCE of ADDITIONAL INCOME:
 ADDITIONAL MONTHLY GROSS:
$
PREVIOUS EMPLOYER:
SPOUSE CO-APPLICANT: Married Unmarried Separated
NAME: NFCU ACCOUNT #:
SOCIAL SECURITY #: DATE OF BIRTH:
DR. LIC. #: STATE: DEPENDENTS’ AGES:
E-MAIL ADDRESS:
ADDRESS:
CITY: STATE: ZIP:
HOME PHONE: HOW LONG:
PREVIOUS ADDRESS:
EMPLOYER: HOW LONG:
POSITION:  
EMPLOYER’S ADDRESS:
CITY: STATE: ZIP:
WORK PHONE: MONTHLY GROSS: $
SOURCE of ADDITIONAL INCOME:
 ADDITIONAL MONTHLY GROSS:
$
PREVIOUS EMPLOYER:
Name & Address Of Creditor Original Amount
Or Credit Limit		 Current Balance Monthly Payment
Buying Own Home
Estimated Value of Property $
Renting $ Other
Is this your primary residence? Yes No 		$ $ $
Mortgage payable to whom? $ $ $
Second Mortgage or Trust Deed? $ $ $
How much do you pay per month for child care, alimony, or support? $ $ $
Other assets that you want considered? $ $ $
Have you ever obtained credit under any other name? Yes No
Are you a co-signer on any other loan? Yes No
Have you ever filed bankruptcy? Yes No
Are there any judgments or liens against you? Yes No
DEBTS YOU INTEND TO PAY OFF WITH THIS LOAN
Lender’s Name Account Number Balance Payment
$ $
$ $
$ $
$ $
$ $
$ $

OPTIONAL GOVERNMENT SURVEY

The following information is requested by the Federal Government for certain types of loans related to dwelling, in order to monitor the Lender’s compliance with equal credit opportunity, fair housing and mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a Lender may neither discriminate on the basis of this information, not on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulation this Lender is required to note race and sex on the basis of visual observation or surname. If you do not with to furnish the above information, please check the appropriate box. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)

Borrower Information
I do not wish to furnish this information.

Race/National Origin:
American Indian, Alaskan Native
Asian or Pacific Islander
Black, not of Hispanic Origin
White, not of Hispanic Origin
Hispanic
Other, Specify
Sex: Female Male
Age:

Co-Borrower Information
I do not wish to furnish this information.

Race/National Origin:
American Indian, Alaskan Native
Asian or Pacific Islander
Black, not of Hispanic Origin
White, not of Hispanic Origin
Hispanic
Other, Specify
Sex: Female Male
Age:

Equal Housing Lender

PLEASE READ BEFORE SIGNING: The terms “I” and “My”, where contained herein, apply to all applicants for credit.

I am submitting this application to the credit union for the purpose of obtaining the credit described above. I certify that this application is true and complete and accurately represents my present financial condition. The credit union may verify this information from whichever sources it deems necessary, and may, now and in the future, provide others with information regarding my credit history with you, to the extent permitted by law. This application remains the property of the credit union even if the credit is denied.

If I have requested joint credit with my spouse/co-applicant, I understand that all applicable agreements shall be binding on both of us, jointly and severally.

PRIMARY APPLICANT

 DATE

 VERIFIED
SPOUSE/CO-APPLICANT

 DATE

 VERIFIED