Primary Applicant

Current Address

Previous Address (if less then 2 yrs at current address)

Employment And Income

Full Legal Name:	Email Address:
Street Address:	City:
State:	Zip Code:
Years At Address:	Own: or Rent:
Home Phone #:	CellPhone #:
Drivers License #:	State Issued:
Social Security #:	Date Of Birth:

Street Address:	City:
State:	Zip Code:
Years At Address:

Employer Name:	Position:
Street Address:	City:
State:	Zip Code:
Hire Date:	Work Phone #:
Supervisor:

I certify that everything I have stated in this application is correct to the best of my knowledge and that the above information is a complete listing of all my debts and obligations. I authorize WESLA Federal Credit Union to check my employment and credit history and to obtain credit reports in connection with this application for credit and for any update, renewal or extension of the credit received. If I request, WESLA Federal Credit Union will tell me the name and address of any credit bureau from which it received a credit report on me. I understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to Federal Credit Unions insured by the NCUA.

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