VSECU LOANLINER Loan Request

If you have previously borrowed from the Credit Union, please complete and submit the form below.

If you are a first-time borrower, please DO NOT use this form. Please print, complete, sign and mail our one-time comprehensive LOANLINER® application, accessible here.

LOANLINER® LOAN REQUEST (FOR PREVIOUS BORROWERS)

VERMONT STATE EMPLOYEES CREDIT UNION
PO Box 67
Montpelier, VT 05601-0067
802/800 371-5162

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.

TYPE AND AMOUNT OF CREDIT YOU'RE REQUESTING

Is this your first loan from us?
yes no

Amount/Credit Limit Requested: $

Approximate Time to Repay: How Many? Periods:

Loan Type:

Loan Type Description (if other):

Security Offered:
(for secured credit only)

Type of Credit: Individual Joint

PAYMENT PROTECTION COVERAGE Check if desired

Check coverage(s) desired. The credit union will disclose the cost of this Payment Protection Coverage to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.

Yes No Do you want your loan protected for you and your family if you become disabled?

Yes No Do you want your loan protected for you and your family in the event of your death?

TELL US ABOUT YOURSELF
(*: required field)

Applicant Co-Applicant

Name: * Name:

Member #: * Member #:

Social Security #: * Social Security #:

Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:
Married
Separated
Unmarried (Single - Divorced - Widowed) Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:
Married
Separated
Unmarried (Single - Divorced - Widowed)

Driver's License #:
State: Driver's License #: State:

Birth Date: Birth Date:

Home Phone: *
Business Phone: Home Phone:
Business Phone:

E-Mail Address: * E-Mail Address:

Note: Please verify that you have entered your valid and correct e-mail address(es) above.
A VSECU Member Service Consultant will contact you via e-mail, from our address info@vsecu.com, regarding the progress of your loan request.

Present Address:
Years There:
Own Rent Present Address:
Years There:
Own Rent

DEBTS DEBTS

Mortgage/Rent owed to: Mortgage/Rent owed to:

Monthly Payment: Monthly Payment:

Property Taxes:
Property Taxes:

INCOME INCOME

Employer: Employer:

Start Date: Start Date:

Gross Income: $
Annual Monthly Bi-weekly Weekly Gross Income: $
Annual Monthly Bi-weekly Weekly

Other Income: (Notice: Alimony,child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)
Source:
$
Annual
Monthly
Hourly Other Income: (Notice: Alimony,child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)
Source:
$
Annual
Monthly
Hourly

By submitting this loan request, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment.

You authorize the credit union to obtain credit reports in connection with this request.