Chestnut Run

Loan Application Submission Instructions:
Send Copies Of Any Bills To Be Consolidated  With The Loan Proceeds To Ensure The Speedy Processing Of Your Loan. When you have completed the application, it can be submitted to the credit union electronically by pressing  the submit button or faxed to the credit union at our Chestnut Run Office on  (302) 999-4889 or at our Glasgow Office on (302) 894-9243. The application can also be mailed to the credit union at the above address.
If you are submitting a Visa Credit Card Application, the application must be printed, signed and either faxed to (302) 999-4889 or mailed to the credit union.  It can not be submitted electronically.

Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself and the Co-Applicant section about your spouse if:

1. You live in or the property pledged as collateral is located in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI),
2. Your spouse will use the account, or
3. You are relying on your spouse's income as a basis for repayment.

If you are relying on income from alimony, child support or separate maintenance, complete the Co-Applicant section to the extent possible about the person on whose payments you are relying.

If you are applying for Joint Credit with another person, complete the Applicant and Co-Applicant sections.

TYPE AND AMOUNT OF CREDIT YOU'RE REQUESTING

Is this your first loan from us?  yes no Where do you want to pick up your loan check?   Chestnut Run Office OR Glasgow Office Amount/Credit Limit Requested:  $Loan Calculator Approximate Time to Repay:  How Many? Periods: Years Months Pay Periods Weeks Loan Type: Boat Computer Debt Consolidation Line of Credit Motorcycle New Auto Recreation Vehicle Used Auto Vacation Visa Credit Card Other Auto Protection Program Security Offered: (for secured credit only, not applicable to credit cards) Type of Credit:  Individual Joint For Credit Cards, see Disclosure Table PAYMENT PROTECTION COVERAGECheck if desired Find out more about Payment Protection Insurance and why it's a better consumer value when offered through your credit union. Click here for the Loan Calculator with Payment Protection Insurance. Check coverage(s) desired. We will disclose the cost of this Payment Protection Insurance - Credit Disability and Credit Life - to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.  Yes No          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? TELL US ABOUT YOURSELF Applicant Co-Applicant Name: Name: CU Account #: CU Account #: Social Security #: 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 (Single - Divorced - Widowed) 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 (Single - Divorced - Widowed) Driver's License #: State: Driver's License #: State: Birth Date: Birth Date: Home Phone: Business Phone: E-Mail Address: Home Phone: Business Phone: E-Mail Address:   Street Address: City, State, Zip: Years There: Own Rent Street Address: City, State, Zip: Years There: Own Rent DEBTS DEBTS Mortgage/Rent owed to: Mortgage/Rent owed to: Balance (Mortgage only): Balance (Mortgage only): Monthly Payment: Monthly Payment: Value Of Home: Value Of Home: Age Of Dependents: Age Of Dependents: INCOME INCOME Employer: Employer Address: Your Title: Supervisor's Name: Employer: Employer Address: Your Title: Supervisor's Name: Employment Start Date: Employment Start Date: Gross Income: $ Annual Monthly Bi-weekly Weekly Gross Income: $ Annual Monthly Bi-weekly Weekly 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: $ 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: $ Annual Monthly Hourly      CREDIT CARD DISCLOSURES Disclosure Table for Chestnut Run FCU Visa Credit Card Annual Percentage Rate (APR), for purchases VISA Platinum - 9.90%-17.90% Grace period for repayment of the balance for purchases 25 Days Grace* Method of computing the balance for purchases AVERAGE DAILY BALANCE INCLUDING NEW PURCHASES* Annual membership fees NONE Minimum finance charge NONE Transaction fee for purchases NONE Transaction fee for cash advances: None  Late-payment fee: $15.00 Over-the-credit-limit fee: $15.00 This information is accurate as of 04/01/03 and is subject to change after that date. Please contact the credit union at (302) 999-2260 for any changes to this information. *A Finance Charge will be imposed on Credit Purchases only if you elect not to pay the entire New Balance shown on your  monthly statement for the previous billing cycle within 25 days from the closing date of that statement. If you elect not  to pay the entire New Balance shown on your previous monthly statement within that 25-day period, a Finance Charge will be imposed on the unpaid average daily balance of such Credit Purchases from the previous statement closing date and on new Credit Purchases from the date of posting to your account during the current billing cycle, and will continue to accrue until the closing date of the billing cycle preceding the date on which the entire New Balance is paid in full or until the date of payment if more than 25 days from the closing date. The Finance Charge for a billing cycle is computed by applying the monthly Periodic  Rate to the average daily balance of Credit Purchases, which is determined by dividing the sum of the daily balances during the billing cycle by the number of days in the cycle. Each daily balance of Credit Purchases is determined by adding to the outstanding unpaid balance of Credit Purchases at the beginning of the billing cycle any new Credit Purchase posted to your account, and  subtracting any payments as received and credits as posted to your account, but excluding any unpaid Finance Charges. A finance  charge will be assessed on cash advances from the date of the cash advance, or the first day of the billing cycle in which the cash advance is posted, whichever is later, and will continue to accrue until payemnt in full is made. Cash Advances will be calculated in the same manner as explained for Credit Purchases. PLEDGE OF SHARES FOR CREDIT CARDS: By submitting this application, you grant us a security interest in the following accounts to secure your credit card agreement. You authorize us to apply the balance in these accounts to any amounts due under these agreements if you should default. If no dollar amount or account number is indicated below, you authorize us to apply any balance in your account at the time of default to pay any amounts due under these agreements. Shares and deposits in an Individual Retirement Account and any other account that would lose special tax treatment under state or federal law if given as a security are not subject to the security interest you have given in your shares and deposits. Amount $ Account # NOTICE TO OHIO RESIDENTS: The Ohio laws against discrimination require all creditors make credit equally available to all credit worthy 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. SIGNATURES: You promise that everything you have stated in this request is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You also agree to notify us of any change in your name, address or employment within a reasonable time thereafter. You authorize the credit union to obtain credit reports in connection with this request. 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. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on requests made to Federal Credit Unions or State Chartered Credit Unions insured by the NCUA. You understand that the credit union will rely on the information in the request and your credit report to make its decision. By signing below, you agree to the terms of the Credit Card Agreement which will be sent with the card and you agree to pay all charges incurred in accordance with the terms of that Agreement. X________________________________ Applicant Signature and Date X________________________________ Co-Applicant Signature and Date 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. If you are submitting a Visa Credit Card Application, the application must be printed, signed and either faxed to (302) 999-4889 or mailed to the credit union.  It can not be submitted electronically. You authorize the credit union to obtain credit reports in connection with this request. Comments: ©CUNA MUTUAL INSURANCE SOCIETY, 1980, 82, 84, 86, 89. ALL RIGHTS RESERVED  CSTLR1 6857 - Internet Loan Request