Georgia Power Valdosta Federal Credit Union

Georga Power Valdosta Federal Credit Union

LOAN APPLICATION

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 (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 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.

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

LOANLINER Account/Loan:

Individual

Joint

Amount Requested $____________

Purpose/Collateral:_____________________

(Including ATM/Debit Card access to the account if Available)

Repayment:

Payroll Deduction

Cash

Military Allotment

Automatic Payment

Other ______________

Payment Protection

Single Credit Disability Insurance

Single Credit Life Insurance

Joint Credit Life Insurance

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 become effective.

Applicant

NAME (last - first - Initial)

MOTHER'S MAIDEN NAME

ACCOUNT NUMBER

SOCIAL SECURITY NUMBER

DRIVER'S LICENSE NUMBER / STATE

BIRTH DATE	HOME PHONE	BUSINESS PHONE / EXT.
	( )	( )

E-MAIL ADDRESS

PRESENT ADDRESS (Street - City - State - Zip)

OWN

RENT

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 - Divorced - Widowed)

EMPLOYMENT/INCOME

START
DATE

NAME AND
ADDRESS OF
EMPLOYER

NOTICE: :

ALIMONY CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED

EMPLOYMENT INCOME

OTHER INCOME

$_______________

PER_______________

$_______________

PER_______________

NET

GROSS

SOURCE______________________________

MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR?

YES

WHERE

ENDING/SEPARATION DATE

Reference

NAME AND ADDRESS
OF NEAREST
RELATIVE NOT
LIVING WITH YOU

RELATIONSHIP

_______________
HOME PHONE

Other

Co-Applicant

Spouse

Guarantor

NAME (last - first - Initial)

MOTHER'S MAIDEN NAME

ACCOUNT NUMBER

SOCIAL SECURITY NUMBER

DRIVER'S LICENSE NUMBER / STATE

BIRTH DATE	HOME PHONE	BUSINESS PHONE / EXT.
	( )	( )

E-MAIL ADDRESS

PRESENT ADDRESS (Street - City - State - Zip)

OWN

RENT

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 - Divorced - Widowed)

EMPLOYMENT/INCOME

START
DATE

NAME AND
ADDRESS OF
EMPLOYER

NOTICE: :

ALIMONY CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED

EMPLOYMENT INCOME

OTHER INCOME

$_______________

PER_______________

$_______________

PER_______________

NET

GROSS

SOURCE______________________________

MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR?

YES

WHERE

ENDING/SEPARATION DATE

Reference

NAME AND ADDRESS
OF NEAREST
RELATIVE NOT
LIVING WITH YOU

RELATIONSHIP

_______________
HOME PHONE

STATE LAW NOTICES

OHIO RESIDENTS ONLY: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

WISCONSIN RESIDENTS ONLY:(1) No provision of any marital property agreement, unilateral statement under Section 766.70, or court decree under 766.70 will adversely affect the rights of the Credit Union unless the Credit Unions furnished a copy of the agreement, statement or decree, 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.

X_______________________________________________________________________________
SIGNATURE FOR WISCONSIN RESIDENTS ONLY Date

Signatures

1. You promise 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 use in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and any update, increase, renewal or extension 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 insured by NCUA.
2. You have received and read the LOANLINER Credit and Security Agreement, including the Addendum ("Agreement"), and a Credit Insurance Certificate. By signing below you agree to be bound by the terms of the agreement.
3. You grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure what you owe under the LOANLINER Credit and Security Agreement. When you are in default, you authorize us to apply the balance in these accounts to any amounts due. Shares and deposits in an Individual Retirement Account, and any other account that would lose special tax treatment under state or federal law if given as security, are not subject to the security to the interest you have given in your shares and deposits.

X	__________________________________________	X	__________________________________________
	Applicants Signature Date		Other Signature Date

Credit Insurance Enrollment Form/Schedule

CUNA MUTUAL INSURANCE SOCIETY • MADISON,WI 53701-0391 • Phone:800/937-2644

"You" or "Your" means the member and the joint insured (if applicable).
Credit insurance is voluntary and not requried in order to obtain this loan. You may select any insurer of your choice. You can get this insurance only if you check the "yes" box below and sign your name and write in the date. The rate you are charged for the insurance is subject to change. You will receive written notice before any increase goes into effect. You have the rite to stop this insurance by notifying your credit union in writting. Your signature below means you agree that:
•   If you elect insurance, you authorize the credit union to add the charges for insurance to your loan each month.
•   You are eligible for insurance if you are working for wages or profit for 25 hours a week or more on the date of the initial advance. If you are not, you will not be insured until you return to work and complete an application for insurance. If you are off work because of temporary layoff, strike or vacation, but soon to resume, you will be considered at work.

•   If you are a homemaker, retiree or student, you are eligible for Credit Life insurance only if you are performing all of the usual duties

YES

of a homemaker, retiree or student in the normal manner on the date of the inital advance and you are not reciving disability benefits from any source. Are you presently actively at work?

• You are eligible for insurance up to the Maximum Age for Insurance. Insurance will stop when you reach that age.

NOTE: The Insurance you're applying for contains certain terms and exclusions; Refer to your certificate for coverage details

YOU ELECT THE
FOLLOWING INSURANCE
COVERAGE(S)

YES

COST PER $100
OF YOUR MONTHLY
LOAN BALANCE

COVERED MEMBER
(please print)

SINGLE CREDIT DISABILITY

23¢

SINGLE CREDIT LIFE

7¢

JOINT CREDIT LIFE

10.5¢

If you are totally disabled for more than 30 days, then the disability benefit will begin with the 1st day of disabillity

ACCOUNT NUMBER	DATE OF ISSUE OF THIS CERTIFICATE

INSURANCE MAXIMUMS	DISABILITY	LIFE
MAX. MONTHLY TOTAL DISABILTY BENEFIT	$ 600	N/A
MAX. INSURANCE BALANCE PER LOAN ACCOUNT	$30,000	$30,000
MAX. AGE FOR INSURANCE	66	71

GROUP POLICY NUMBER

010-0354-3

SECONDARY BENEFICIARY (If you desire to name one)

DATE	MEMBER'S DATE OF BIRTH	DATE	JOINT INSURED'S DATE OF BIRTH

X	__________________________________________	X	__________________________________________
	Applicants Signature Date		Other Signature Date
	SIGNATURE OF MEMBER (Be sure to check one of the boxes above)		SIGNATURE OF JOINT INSURED (CO-BORROWER) (Only requried if JOINT CREDIT LIFE coverage is selected)

For Credit Union Use Only

DATE

APPROVED

SIGNATURE

LINE OF CREDIT

OTHER

DEBT RATIO/SCORE

DENIED
(Adverse Action Notice Sent)

LIMITS:

BEFORE AFTER

LOAN OFFICER COMMENTS:

Signature:
X_______________________________________
Date

You Must Print, Sign, and Return to Credit Union