Port Terminal Federal Credit Union Loan Application
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Please print this form, fill it out and fax to
713.926.9928
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General Information:
 Will there be a co-applicant on this application: Yes No
 Marital Status: Complete marital status if this loan is for:
 a. Joint or secured credit, or
 b. 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 loan is not for joint or secured credit and I do not live in the states listed above.
 Type of Loan Requested:
 Loan Amount Requested:  Loan Term Requested:
 Primary Applicant:
 Last Name:  Member Number:
 First Name:  Middle Name:
 Social Security Number (TIN):  Date of Birth:
 Number of Dependents:  Ages of Dependents:
 Home Phone Number:  Work Phone Number:
 Other Phone Number:  Email Address:
 Drivers License #:  Drivers License State:
 Home Address
 Address 1:
 Address 2:
 City:  State, Zip:
 Time at Current Residence:  Residence Type: Rent Own Other:
 Monthly Payment:
 Previous Address
 Address 1:
 Address 2:
 City:  State, Zip:
 Time at Previous Residence:  Residence Type: Rent Own Other:
 Present Employer
 Name:  Phone Number:
 Employment Status: Full Time Part Time Temp Retired Other (please specify):
 Job Title:  Job Start Date:
 Gross Salary:  per Year Month Hour
 Other Income:  per Year Month Hour
 Other Income Source:  
 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.
 Previous Employer
 Name:  Phone Number:
 Employment Status: Full Time Part Time Temp Retired Other (please specify):
 Job Title:  Job Start Date:
 Job End Date:  
 Gross Salary:  per Year Month Hour
 Co-Applicant:
 Last Name:  Member Number:
 First Name:  Middle Name:
 Social Security Number (TIN):  Date of Birth:
 Number of Dependents:  Ages of Dependents:
 Home Phone Number:  Work Phone Number:
 Other Phone Number:  Email Address:
 Drivers License #:  Drivers License State:
 Home Address
 Address 1:
 Address 2:
 City:  State, Zip:
 Time at Current Residence:  Residence Type: Rent Own Other:
 Monthly Payment:
 Previous Address
 Address 1:
 Address 2:
 City:  State, Zip:
 Time at Previous Residence:  Residence Type: Rent Own Other:
 Present Employer
 Name:  Phone Number:
 Employment Status: Full Time Part Time Temp Retired Other (please specify):
 Job Title:  Job Start Date:
 Gross Salary:  per Year Month Hour
 Other Income:  per Year Month Hour
 Other Income Source:  
 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.
 Previous Employer
 Name:  Phone Number:
 Employment Status: Full Time Part Time Temp Retired Other (please specify):
 Job Title:  Job Start Date:
 Job End Date:  
 Gross Salary:  per Year Month Hour
 References
 Nearest Relative Not Living With You
 Last Name:  First Name:
 Relationship:  Phone Number:
 Address 1:
 Address 2:
 City:  State, Zip:
 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.
 Debt Monthly Payment   Debt Monthly Payment 
       
       
       
 Additional Information
 How would you prefer to be contacted?
  Home Phone
  Work Phone
  Other Phone
  Email Address
  Other:
 Special Instructions/Comments:
 
 
 
 Signatures
Income verification is required; other information may be required.

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 Financial Institution, information concerning me or my affairs.(Sec. 1014, Title 18, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.)
 Primary Signature:  Date:        
 Joint Owner Signature:  Date: