Eugene Loan Application

Married Applicants may apply for a separate account. Check the type of credit account for which you wish to apply.

Individual Credit - You must complete the applicant section about yourself and the other section about your spouse if: (1) You live in a community property state (AK, AZ, CA, ID, LA, NM, NV, P.R., TX, WA, WI); (2) your spouse will use the account; or (3) you are relying on your spouse’s income as a source of repayment.

Joint Credit - If you are applying for a joint account or an account that you and another person will use, you must complete the applicant and other applicant sections.

Individual CreditJoint Credit

Purpose of Loan


Amount Requesting


Desired Monthly Payment


How Did You Hear About Us?

Personal Information

First Name
Middle Initial
Last Name
Email
Number of Dependents and Ages
Birthday
Social Security
Drivers License Number
Home Phone
Cell Phone

Personal Information - Co-Applicant

First Name
Middle Initial
Last Name
Email
Birthday
Social Security
Drivers License Number
Home Phone
Cell Phone

Present Address

Physical Address
City
State
Zip Code
Time at Address (Months / Years)
Housing Status
Monthly Rent Amount
Landlord / Mortgage Company
Time In Area

Previous Address

If less than 3 years at present address

Physical Address
City
State
How Long?

Physical Address
City
State
How Long?

Present Employment

Employer
Employer Address
Position
Phone
Supervisor's Name
Date Employed (Month / Year)
Frequency of Pay (Monthly / Semi-Monthly / Bi-Weekly / Weekly)
Net Amount Per Check

Present Employment - Co-Applicant

Employer
Employer Address
Position
Phone
Date Employed (Month / Year)
Frequency of Pay (Monthly / Semi-Monthly / Bi-Weekly / Weekly)
Net Amount Per Check

Previous Employment

If less than 2 years at present employer

Employer
Position
Phone
Date Employed (Month / Year)
Years at Previous Employer
Months at Previous Employer

Previous Employment - Co-Applicant

If less than 2 years at present employer

Employer
Position
Phone
Date Employed (Month / Year)
Years at Previous Employer
Months at Previous Employer

Bank Information

Checking?
Savings?
Name of Bank
Average Balance

Other Income

Notice: Income from alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered for repayment of this obligation.

Source
Net Monthly Amount

Miscellaneous Criteria

Have you ever declared bankruptcy?

Do you currently have unsatisfied judgements?

Have you ever been subject to repossession of property?

Are your wages currently being garnished?

Assets

Year
Make
Model
VIN
Body Style
Mileage
Color of Vehicle
Insurance Company Name

Year
Make
Model
VIN
Body Style
Mileage
Color of Vehicle

Monthly Payment Amount

Monthly Cell Payment
Monthly Electricity
Monthly NW Natural Gas
Monthly Water/Sewer/Garbage
Monthly Auto Insurance
Monthly Cable / Internet
Monthly Daycare / Childcare

Debts

Creditor (Car Loan)
Balance
Payment

Creditor
Balance
Payment

Creditor
Balance
Payment

Creditor
Balance
Payment

Creditor
Balance
Payment

Anything we missed?

This loan application will go to our Eugene Office. To submit an application to another office, visit our loan application page.