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Loan Application

Please complete the application to the best of you ability.  We may contact you for more information so please list the best way to reach you.  If any other details are necessary to process this application please enter that information in the "Comments" box.  If you have any questions about this process or want to know your application status, please call (920)233-1140.

Applicant Information
First Name:
Last Name:
Address Street 1:
Address Street 2:
Zip Code: (5 digits)
Co-Applicant Information
First Name:
Last Name:
Contact Information
Daytime Phone:
Evening Phone:
Financial Information
Loan Type:
Loan Amount: (USD)
Property Information
Property Type:
Purchase Price: (USD)
Appraised Value: (USD)
Mortgage Balance: (USD if applicable)
Other Information
Income from alimony/child or spousal support payments need not be revealed unless you want the credit union to consider them as a basis for repayment of debt.

Notice to Wisconsin Residents:
No provision of a marital property agreement, a unilateral statement under Wis. Stat. SEc. 766.59 or a court decree under Wis. Stat. Sec. 766.70 adversely affects the interests of the credit union unless prior to the time the credit is extended, the credit union is furnished with a copy of the agreement, statement or decree, or has actual knowledge of the adverse provision when the obligation to the credit union is incurred.

Please note: Income verification and other information may be required.

I /we agree that, by submitting this application, we certify that the foregoing information has been supplied truthfully, accurately and voluntarily, and therefore authorize this credit union to investigate our creditworthiness, credit history, and financial responsibility through any credit bureau or by any other reasonable means. If I am married, applying for individual credit, and living in a community property state, I certify that the credit being applied for, if granted, will be incurred in the interest of the marriage or family. If this statement applies, we are required by Wisconsin law to notify your spouse by mail if your loan is granted.

I authorize Health Care Credit Union to verify
my credit and employment history.