Loan Application

Please provide all of the requested information. When you have completed the application, press the Submit button to send it to Mid American Credit Union.

This is an application for INDIVIDUAL CREDIT.

This is an application for JOINT CREDIT. Please enter the initials of both applicants to indicate agreement of a joint credit application: Applicant 1:   Applicant 2:

 

Today's Date 
Lease:
Yes No
Loan:
Yes No
Amount Requested
Term (in months)

Purpose of Loan




Collateral Available
(Please be specific, for example, "1994 Chevrolet Pick-Up". If no collateral, state "none".):

Description:

Identification Number (if applicable):


Personal Information
I am a MidAmerican Member: Yes No Member Account
Name (Last, First, MI)
Phone
Social.Security.No.
Birthdate
Address
City
State
Zip
Rent: Yes No
Own: Yes No
Years There

Employment
Present employer
City
State
Zip Code
Position
Work Phone
Years There

Relative (not living with you)
Name (Last, First, MI)
Relationship
Phone Number

Joint Applicant Information
Name(Last, First, MI)
Phone
Social.Security.No.
Birthdate
Address..(if..different.)
City
State
Zip
Rent: Yes No
Own: Yes No
Years There

Joint Applicant Employment
Present employer
City
State
Zip Code
Position
Work Phone
Years There

Joint Applicant Relative (not living with you)
Name (Last, First, MI)
Relationship
Phone Number

Income Information*

*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 loan.

Borrower's gross monthly income
Borrower's other monthly income
Borrower's source of other income
Joint Applicant's gross monthly income
Joint Applicant's other monthly income
Joint Applicant's source of other income
Total of
Monthly Income(s)


Monthly Rent or Mortgage Payment Information
Mortgage Co./Landlord Name
Appraised value
Balance
Payment

By submitting this application, I (we) certify that everything I (we) have stated in this application is correct. You may keep this application whether or not it is approved. I (we) also authorize you to check my (our) credit and employment history and to answer questions others may ask you about my (our) credit record with you. I (we) understand that I (we) must update credit information at your request if my (our) financial condition changes.


We will process your loan upon receipt. Please tell us how you would like us to respond:
Desktop banking under
my account number (secure)
E-mail (not secure)

Daytime Phone

Fax


Mid American Credit Union8404 West Kellogg DriveWichita, KS 67209316.722.3921Fax 316.722.0920