This application is for members of:
Landmark Credit Union
PO Box 150
5705 Valley Road
Fairfield, AL 35064

Individual Credit: You must complete the Applicant section about yourself and the Other 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 Other section to the extent possible about the person on whose payments you are relying.

Joint Credit: If you are applying with another person, complete the Applicant and Other sections.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.

Check below to indicate the type of account(s) and
type of credit for which you are applying.
Married Applicants may apply for a separate account.

Account/Loan: Individual  Joint
Amount Requested $  Purpose/Collateral
(Including ATM/Debit Card Access to the Account if Available)

Applicant
First Name
MI
Last Name
Mother's Maiden Name
Account #
SSN
Driver's License Number/State
Email Address
Birth Date
Home Phone
Business Phone/Ext
Present Address
Own      Rent
City
State
Zip
Years At This Address
Mortgage/Rent Owed To:
Mortgage Balance
Monthly Payment
$
Interest Rate
%
Complete for joint credit, secured credit, or if you live in a community property state
Married  Separated  Unmarried (Single - Divorce - Widowed)
Employment/Income
 Employer Name
Employer Address
Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income
$ per
Other Income
$ per
Net Gross Source
Other   Co-Applicant  Spouse  Guarantor
First Name
MI
Last Name
Mother's Maiden Name
Account #
SSN
Driver's License Number/State
 
Birth Date
Home Phone
Business Phone/Ext
Present Address
Own      Rent
City
State
Zip
Years At This Address
Mortgage/Rent Owed To:
Mortgage Balance
Monthly Payment
$
Interest Rate
%
Complete for joint credit, secured credit, or if you live in a community property state
Married  Separated  Unmarried (Single - Divorce - Widowed)
Employment/Income
 Employer Name
Employer Address
Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income
$ per
Other Income
$ per
Net Gross Source
State Law Notices

OHIO RESIDENTS ONLY: The Ohio laws discrimination require that 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 administrators compliance with this law.

WISCONSIN RESIDENTS ONLY:(1)No provision of any marital properly agreement unilateral statement under Section 766.59, or court degree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is Furnished a copy of the agreement, statement or degree, or has actual knowledge of its terms, before the credit is granted or the account is opened.  (2)Please sign if you are not applying for this account or loan with your spouse.  The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

Signature(s)

You agree that everything you have stated in this application is correct to the best of your knowledge.  If there are any important changes you will notify us in writing immediately.  You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension, or collection of the credit received.  You understand that the Credit Union will rely on the information in this application and your credit report to make its decision.  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.  It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions.


Applicant Signature

Other Signature

Processing of loan application cannot occur unless all information is provided.


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