River Region Loan Application

Individual Credit: You must complete the Applicant section about yourself an the Other section about your spouse if:
1. You live in or the property pledged as collateral is located in a community property state (AK,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 incomeas a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance. complete the Other section to extent possible about the person on whose payments you are relying.
Joint Credit: each applicant must individually complete the appropriate section below. If Co-Borrower is spouse of the applicant mark the Co-Applicant box.
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.
Required fields marked with a
Loan Type: Invalid Input
Amount Requested: Purpose/ Collateral: Repayment: Invalid Input
Payment Protection: Invalid Input
Check coverage(s) desired. The credit union will disclose the cost of this voluntary insurance to you. A separate insurance election which discloses the terms and conditions must be signed for coverage to be effective

Applicant Information
First Name
Last Name
Account Number Invalid Input Social Security Number
Drivers License # / State
Invalid Input Invalid Input
List Ages of dependents not listed by other applicant Invalid Input
Birth Date
Email Address
Invalid Input
Primary Phone Invalid Input Secondary Phone
Present Address
Street
City
State
Zip
Own / Rent - Years At Address
Previous Address
Street
City
State
Zip
Own / Rent - Years At Address
Complete for Joint Credit :
If married please complete below:
Spouse's Name:
Spouse's SSN:
CO - Applicant Information
First Name
Last Name
Account Number
Invalid Input
Social Security Number
Invalid Input
Drivers License # / State
Invalid Input Invalid Input
List Ages of dependents not listed by other applicant Invalid Input
Birth Date
Email Address
Invalid Input
Primary Phone Secondary Phone
Present Address
Street
(*)
City (*)
State (*)
Zip (*)
Own / Rent - Years At Address
Previous Address
Street (*)
City (*)
State (*)
Zip (*)
Own / Rent - Years At Address
Complete for Joint Credit:
If married please complete below:
Spouse's Name
Spouse's SSN


APPLICANT Employment Income
Name of Employer
Address Of Employer Invalid Input
Business Phone
Title
Invalid Input
Start Date
Hours at Work
Invalid Input
Supervisor's Name
If Self Employed - Type of Business
Invalid Input
Employment Income Other Income
$ Invalid Input PER Invalid Input $ Invalid Input PER Invalid Input
Invalid Input Source Invalid Input
Previous Employer Name
Start Date Invalid Input
Previous Employer Address
Invalid Input
End Date Invalid Input
Military Info Invalid Input
CO-APPLICANT Employment Income
Name of Employer Invalid Input
Address Of Employer Invalid Input
Business Phone
Title
Invalid Input
Start Date
Hours at Work
Invalid Input
Supervisor's Name
If Self Employed - Type of Business
Invalid Input
Employment Income Other Income
$ PER Invalid Input $ PER Invalid Input
Source Invalid Input
Previous Employer Name Invalid Input Start Date
Invalid Input
Previous Employer Address Invalid Input End Date
Invalid Input
Military Info Invalid Input


Applicant Reference
Name
Invalid Input
Relationship
Invalid Input
Address
Invalid Input
Phone
Invalid Input
Other Reference
Name
Relationship
Invalid Input
Address
Invalid Input
Phone
Invalid Input

What you owe Creditor Name Interest Rate Present Balance Monthly Payment
Owned By
Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input
Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input
Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input
Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input
Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input
Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input
Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input
Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input
Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input
Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input Invalid Input

What you Own Address of Property or
Financial institution
Market Value collateral
for another loan ?
Owned By
Home Invalid Input Invalid Input Invalid Input Invalid Input
Auto Invalid Input Invalid Input Invalid Input Invalid Input
Savings Invalid Input Invalid Input Invalid Input Invalid Input
Checking Invalid Input Invalid Input Invalid Input Invalid Input
Other Invalid Input Invalid Input Invalid Input Invalid Input

Other Information Applicant Other
Are you a U.S. Citizen or Permanent Resident Alien ? Invalid Input
Do you curently have any outstanding judgements or have you ever filed for bankruptcy, had a debt reduction plan confirmed under chapter 13, had the property foreclosed or repossessed in the last 7 years, or been a party in a lawsuit? Invalid Input
Is your income likely to decline in the next two years? Invalid Input
Are you a CoMaker, Co-signer, or Guarantor on any loan not listed above? Invalid Input