Welcome to Lacamas Community Credit Union

Online Loan Application

Loan Request Information:

Are you a Member?:	Yes No
If yes, Member Number:
Purpose of Loan:
Amount of Loan: $
Name:
Social Security Number:
Birthdate:
Marital Status (If you live in a community property state):	Married Unmarried Separated
Do You:	Own Rent
Home Address:
How long have you lived at this address?	Years Months
Monthly rent or mortgage payment? $
Home Phone Number:
Email:
Preferred method of communication:	Home Phone Work Phone Email
Best time to contact:	Morning Afternoon Evening

Employment Information:

Name of Employer:
Phone Number of Employer:
Gross Monthly Salary: $
Length of Employment:	Month: Year:
Position or Job Title:
Please list any other income. You need not list income from Alimony, Child Support, or Separate Maintenance unless you wish it considered for purposes of granting this credit. Include the source and the monthly dollar amount:

Co-Borrower Information:

Complete this section only for: (i) joint credit; (ii) with spousal information if your spouse will use or be liable on the account, you will rely on your spouse's income to pay the debt or if you reside in a community property state.

Are you applying for joint credit:	Yes No
Co-Borrower's Name:
Co-Borrower's Social Security Number:
Home Address:
Birthdate:
Your relationship to Co-Borrower:

Co-Borrower Employment Information:

Name of Employer:
Phone Number of Employer:
Gross Monthly Salary: $
Length of Employment:	Month: Year:
Position or Job Title:

By submitting this application you are authorizing us to obtain credit reports and make any inquiries we consider appropriate for this application and to tell others about our credit experience with you.

Special Note: Verification of income and other supporting documentation may be required to complete the processing of this loan application.