Baptist Hospital Credit Union Loan Application Page

Baptist Hospital Credit Union

LOAN APPLICATION

Please complete this form on screen, print it out, sign where indicated and
mail, fax or bring to the credit union.

There is a $20.00 fee for submitting your loan application.

Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself and the Co-Applicant section about your spouse if:

Your spouse will use the account, or
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 Co-Applicant section to the extent possible about the person on whose payments you are relying.

If you are applying for Joint Credit with another person, complete the Applicant and Co-Applicant sections.

PRIMARY APPLICANT

Purpose of Loan	Amount Requested	Term of Loan
Individual Applicant Joint Applicant
Married Separated Unmarried
U.S. Citizen Yes No
Member Number	Date
First Name	MI Last Name SSN
No. of Dependents Ages of Dependents Driver's License State Date of Birth
Present Street Address City St Zip How Long? (Do not use P.O. Box)
Previous Street Address City St Zip How Long? (Do not use P.O. Box)
Home Phone Work Phone & Ext. E-mail Address
Present Employer
Street Address City St Zip
Current Occupation Position/Dept.
Supervisor Date Hired Monthly Salary
Source of other monthly income: Other Income Property, Investments, Social Security, CD's, etc.

SPOUSE

If not married to each other, please complete separate application
U.S. Citizen Yes No
First Name	MI Last Name SSN
No. of Dependents Ages of Dependents Driver's License State Date of Birth
Present Street Address City St Zip How Long? (Do not use P.O. Box)
Previous Street Address City St Zip How Long? (Do not use P.O. Box)
Home Phone Work Phone & Ext. E-mail Address
Present Employer
Street Address City St Zip
Current Occupation Position/Dept.
Supervisor Date Hired Monthly Salary
Source of other monthly income: Other Income Property, Investments, Social Security, CD's, etc.

DEBTS AND OBLIGATIONS

Buying Own Home Renting Other	Market Original Current Monthly Value Amount Balance Payment
Second Mortgage or Trust Deed (Name & Address of Lien Holder)
Auto (Yr, Make, Model)
Owned Financed
Financed by	Amount Balance Payment
Auto Insurance Company
Alimony, Child support, Other

CREDIT CARDS

APPLICANT REFERENCES

Nearest Relative not living with you:
Name	Relationship
Address	Home Phone
City St Zip

Name	Relationship
Address	Home Phone
City St Zip

CREDIT CARD DISCLOSURES

The information about the costs of the card described in this application is accurate as of 8/05. This information may have changed after that date. To find out what may have changed, call or write to us.
Annual percentage rate for purchases and cash advances	6.9% (Secured) 8.9% (Unsecured) 12.9% (Unsecured) 14.9% (Unsecured)
Grace period for repayment of the balance for purchases	25 days
Method of computing the balance and cash advances	Average Daily Balances (Including new purchases)
Minimum Finance charge	None
Transaction fee for purchases	None
Annual Fee	None
Other Fees: Foreign Transaction Fee Over-Credit-Limit Fee Late Payment Fee (if ten (10) or more days late)	1% of Transaction Amount $20.00 $20.00

SIGNATURES

You promise that everything you have stated in this request is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You also agree to notify us of any change in your name, address or employment within a reasonable time thereafter. You authorize the credit union to obtain credit reports in connection with this request. 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. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on requests made to Federal Credit Unions or State Chartered Credit Unions insured by the NCUA. You understand that the credit union will rely on the information in the request and your credit report to make its decision.

X___________________________________
Applicant Signature and Date

X___________________________________
Co-Applicant Signature and Date

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Your savings federally insured to at least $250,000 and backed by the full faith and credit of the United States Government. National Credit Union Administration, a U.S. Government Agency.