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BUCKEYE STATE CREDIT UNION
LOAN REQUEST

BUCKEYE STATE CREDIT UNION, INC.

Your location:
 
   

PERSONAL INFORMATION
Name
Home Phone
Social Security
Birth Date
Home Address
City
State
Zip Code
Since
Email Address
 

EMPLOYER INFORMATION
Employer
Phone
Job Description
Hire Date
Employer Address
City
State
Zip Code
Previous Employer
No. Years/Months
Termination Date

INCOME INFORMATION
Income: Please Attach Verification of Income.
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.
Year
Reg. Income *
Overtime
Other Income
Other Description
Year
Reg. Income *
Overtime
Other Income
Other Description
 
* Please Note As To Whether Income is Per Hour, Week, Month, or Year.

Will any income listed be reduced before loan is paid off?   No   Yes   
 
If yes, explain



Nearest Relative Not Living with You
Relationship
Phone
Address
City
State
Zip Code



If you are applying for this loan with a co-applicant/spouse, you must also fill in all the information in the gray background sections below. Otherwise, skip the gray background sections and continue.

CO-APPLICANT/SPOUSE PERSONAL INFORMATION
Co-Applicant/Spouse
Home Phone
Social Security
Birth Date
Home Address
City
State
Zip Code
Since

CO-APPLICANT/SPOUSE EMPLOYER INFORMATION
Co-Applicant/Spouse Employer
Phone
Job Description
Hire Date
Employer Address
City
State
Zip Code

CO-APPLICANT/SPOUSE INCOME INFORMATION
Co-Applicant/Spouse Income: Please Attach Verification of Income.
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.
Year
Reg. Income *
Overtime
Other Income
Other Description
Year
Reg. Income *
Overtime
Other Income
Other Description
* Please Note As To Whether Income is Per Hour, Week, Month, or Year.

Will any income listed be reduced before loan is paid off?   No   Yes 
If yes, explain



Loan Purpose
Amount Requested
Payment
Collateral/Security Offered

Months #PAY: 

Months FREQ: 






The above information is true to the best of my knowledge. I hereby authorize the Buckeye State Credit Union or its designee to obtain any information relevant to my application for a loan. Also, I authorize BSCU to obtain a report of my credit history and signature prior to disbursement of loan.

Member: I hereby attest that the above statement is true.
 I Agree
Application Date

NOTICE TO ALL OHIO RESIDENTS:
"The Ohio laws against 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 administers compliance with this law."

If you choose not to submit this form via the internet, you can fill it out and print it and then mail or fax it to Buckeye State Credit Union.
Submitted online applications are securely transmitted. Once the branch reviews the information, they will contact you. You will be asked to visit your local branch to sign the final paperwork to become a member.