Loan Application

In order to qualify for membership and a loan with Chocolate Bayou Credit Union, you must live, work, or worship in Brazoria County.

Please enter your account number*

Please enter your social security number*

First Name*

Last Name*

Email Address*

Notes (enter any special offer information here)

Individual

Joint

Amount Requested*

Purpose for loan* (please be specific e.g., bill consolidation, new furniture, auto, etc.)

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.

Single Credit Disability Insurance

Single Credit Life Insurance

Joint Credit Life Insurance

Joint Credit Disability Insurance

None

NOTICE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered

Address

Own Rent

Monthly Payment*

Address*

City*

State*

Zip*

Years at this address*

Complete for joint credit, secured credit or if you live in a community property state:*
Married Separated Unmarried ( Single - Divorced - Widowed )

Employment

Are you currently employed?*

Yes No

Applicant Reference

Please provide a reference to the nearest relative not living with you.

Name*

Phone Number*

Relationship*

Other Information

If you answer yes to any question other then #1 please explain.

1. Are you a citizen or permanent resident alien?*

YesNo

2. Do you currently have any outstanding judgments or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit?*

YesNo

3. Is your income likely to decline in the next two years?*

YesNo

4. Are you a co-maker, co-signer or guarantor on any loan not listed above?*

YesNo

NOTICE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered

Co-Applicant Spouse Guarantor Not-Applicable

1. You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. 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 decisions. 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 for federal credit unions or state chartered credit unions insured by NCUA.

I Agree