Applications

Qualification for membership in the Credit Union: *

Choose 1

I am a current member of the Credit Union.

I live or work in Andrew, Atchison, Gentry, Holt, Nodaway, or Worth County, Missouri.

I am a NWMSU Student, Alumni, Retiree or Employee.

I am an employee of a school district in Northwest Missouri.

I am a relative of a current member of the Credit Union.

Check below to indicate the type of account(s) and type of credit for which you are applying. Married Applicants may apply for a separate account. *

LOANLINER Account/Loan:

Individual Loan

Joint Loan

Method of Repayment *

Payroll Deduction

Cash

Military Account

Automatic Payment

Name *

First Name

Last Name

Home/Cell Phone *

(###)

###

####

Business/Work Phone

(###)

###

####

Present Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you *

Own

Rent

*

Length of time at this residence in:

Years (or)

Months

Previous Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Did you *

Own

Rent

*

Length of time at this residence in:

Years (or)

Months

Complete for joint credit, secured credit or if you live in a community property state: *

Married

Separated

Unmarried (Single - Divorced - Widowed)

Address of Employer/Income Source *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Start Date *

MM

DD

YYYY

Income Pay Frequency *

Select how often you receive the income above.

Hourly$

Weekly$

Bi-Weekly$

Semi-Monthly$

Monthly$

Annually$

Income listed is: (choose one) *

Choose One

Gross (before taxes)

Net (after taxes)

Starting Date

MM

DD

YYYY

Ending Date

MM

DD

YYYY

Military: Is duty station transfer expected during next year?

Yes

No

Ending/Separation Date

MM

DD

YYYY

Borrower Type:

Co-Applicant

Spouse

Guarantor

Name

First Name

Last Name

Home/Cell Phone

(###)

###

####

Business/Work Phone

(###)

###

####

Present Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you

Own

Rent

Length of time at this residence in:

Months (or)

Years

Previous Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Did you

Own

Rent

Length of time at this residence in:

Months (or)

Years

Complete for joint credit, secured credit or if you live in a community property state:

Married

Separated

Unmarried (Single - Divorced - Widowed)

Address of Employer/Income Source

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Start Date

MM

DD

YYYY

Income Pay Frequency

Select how often you receive the income above.

Hourly$

Weekly$

Bi-Weekly$

Semi-Monthly$

Monthly$

Annually$

Income listed is:

Choose One

Gross (before taxes)

Net (after taxes)

Starting Date

MM

DD

YYYY

Ending Date

MM

DD

YYYY

Military: Is duty station transfer expected during next year?

Yes

No

Ending/Separation Date

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date Hired *

MM

DD

YYYY

Next Payday *

MM

DD

YYYY

Pay Frequency *

Weekly

Bi-Weekly

Semi-Monthly

Monthly

Currently in process of filing bankruptcy *

Yes

No

Please read before submitting. Check box to agree. *

I understand I will be charged a $25 non-refundable application fee.

I understand that Northwest Missouri Regional Credit Union will obtain a credit report.

10% of the loan proceeds will be pledged in savings account “H”. Once the loan is paid in full the funds will be released.

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Cell Phone

(###)

###

####

ATM Debit Card Fraud Alerts: I can receive notifications by text/SMS messaging. (check one) *

Yes

No

Opt In/Out: Debit cards are automatically opted into an automatic billing updating service. This service provides debit card updates to merchants you have an established recurring payment agreement with such as a utility company or cell phone provider. To opt out of this automatic billing updating service check the appropriate box below:

Primary Cardholder

Joint Cardholder