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					                                                 Cover Sheet Information
                     PLEASE COMPLETE BOTH THE COVER SHEET AND THE LOAN APPICATION
                                      AND FAX BACK TO (330) 379-6657



1. Credit Union Account Number __________________________________________

2. Purpose of loan (or advance) ____________________________________________

3. Amount of money needed $________________ Term of Loan (in months) __________

4. Will this loan be payroll deducted? YES/NO (Circle One)

5. If self employed you must document income with your last 2 years tax returns.

6. WE WILL NEED A CLEAR TITLE TO THE COLLATERAL YOU OFFER

   Year ___________________ Make _____________________ Model_________________________

7. Name of dealer or private owner _______________________________________________________

   Is car being ordered ?_____________________________ On the lot? _________________________
   (Return a copy of the purchase order if vehicle bought from a dealer)

8. In whose name will the vehicle be titled? ________________________________________________
                                                   (this person signs the security agreement)

IF YOU ARE OFFERING COLLATERAL YOU ARE REQUIRED TO CARRY FULL INSURANCE COVERAGE. YOU WILL
NEED TO PROVIDE THE FOLLOWING INFORMATION:

9. Insurance Company _______________________________     Agent Name__________________________________

   Phone No.________________________

PLEASE NOTE: For non-BFS employees – Would you like to have an electronic funds transfer from your pay?
If yes, ask your employer about ACH transfers and provide them with our ACH routing number: 2412-7324-3


                                             CALL US FOR LOAN APPROVAL
                                                     1-800-648-3328
PERSONAL AND CREDIT INFORMATION – FIRESTONE FEDERAL CREDIT UNION                                                                                    COMAKER FOR ______________________
APPLICATION MUST BE COMPLETED IN FULL & SIGNED IN INK (PRINT OR TYPE)                                                                               ACCT. NO __________________________
ACCOUNT NO._________________________                                                                                                                RELATIONSHIP________________________

 FIRST NAME                           INITIAL      LAST NAME                                       HAVE YOU TAKEN BANKRUPTCY?                         YES        NO        YEAR
                                                                                                   IS LITIGATION PENDING AGAINST YOU?                 YES        NO        YEAR
 RESIDENCE ADDRESS                                                                                 HOMEOWNERS PLEASE COMPLETE
                                                                                                   PURCHASE PRICE          YEAR                     BALANCE OWED             EST. VALUE

 CITY                                 STATE        ZIP CODE                COUNTY                  AUTOMOBILE YEAR                                  MAKE                     MODEL


 HOME NO.                    CELL NO.                     YEARS THERE                OWN          AUTOMOBILE YEAR                                  MAKE                     MODEL
 (     )                     (      )                                                RENT
                                                                                     BOARD
 S.S.#                                             BIRTH DATE              AGE                     AUTOMOBILE YEAR                                  MAKE                     MODEL


 PREVIOUS ADDRESS (IF PRESENT LESS THAN 2 YEARS)                           COUNTY                  NEAREST RELATIVE NOT LIVING WITH YOU PHONE                                RELATIONSHIP

 CITY                                 STATE        ZIP CODE                                        STREET                               CITY                     STATE       ZIP CODE

 NUMBER             THIS INFORMATION NEED NOT BE     UNMARRIED                                    OTHER REFERENCE (REQUIRED) PHONE                              RELATIONSHIP
 DEPENDENTS         COMPLETED IF THIS IS A REQUEST   MARRIED
 EXCLUDE SELF       FOR INDIVIDUAL CREDIT            SEPARATED
 NOW EMPLOYED BY/SELF-EMPLOYED MUST DOCUMENT INCOME                                                STREET                               CITY                     STATE       ZIP CODE


 COMPLETE BUSINESS ADDRESS                                                                         ARE YOU A COMAKER?                   YES         NO         WHERE?

                                                                                                   HOW MUCH?                  FOR WHOM?                   ACCT. #
 CITY                                     STATE                             ZIP CODE               YOU ARE NOT REQUIRED TO DISCLOSE INCOME FROM ALIMONY, CHILD SUPPORT
                                                                                                   OR MAINTENANCE BUT IF YOU WANT IT CONSIDERED IN CONNECTION WITH THE
                                                                                                   APPLICATION COMPLETE THE FOLLOWING:
 TELEPHONE AT WORK                                                         DATE EMPLOYED
 AREA CODE (    )                                                                                  $                           PAYOR
 POSITION/JOB                              FULL                  MONTHLY GROSS INCOME             COMPLETE THIS SECTION IF SOMEONE WILL HELP MAKE PAYMENTS,
                                           PART-TIME             $                                INCLUDE SPOUSE DEBTS BELOW.
 PREVIOUS EMPLOYER                                                      YEARS THERE                NAME                                  S.S.#
                                                                                                                                         BIRTH DATE    /     /
 ADDRESS                                         PREV. MONTHLY INCOME                              EMPLOYED BY                          ADDRESS
                                                 $
 OTHER INCOME (EXCLUDE ALIMONY, CHILD SUPPORT AND MAINTENANCE                                      DATE EMPLOYED                    TELEPHONE NO.                     MONTHLY GROSS
 PAYMENTS)                                                                                                                          (     )                           INCOME
 $                 SOURCE
                                    WHERE                     $                                      WHERE                               $

 SAVINGS ACCOUNT                                                                                                                                               SAVE WITH US!
  STATEMENT OF TOTAL INDEBTEDNESS AND LIABILITIES (BILLS) ON ALL SINGLE AND JOINT ACCOUNTS INCLUDING HOUSE. ATTACH LISTING FOR ANY ADDITIONAL
  BILLS. INCOMPLETE LISTING MAY DELAY PROCESSING – THIS SECTION MUST BE ANSWERED.
  UNSECURED LOANS                  OWED TO                            INTEREST          COLLATERAL                 BALANCE OWING               MONTHLY PAYMENT              AMOUNT PAST DUE
                                                                      RATE                                                                     AMOUNT
  CREDIT UNION
  CREDIT CARD
  CREDIT CARD
  CREDIT CARD
  STUDENT LOANS
  SECURED LOANS                    OWED TO                            INTEREST          COLLATERAL                 BALANCE OWING               MONTHLY PAYMENT              AMOUNT PAST DUE
                                                                      RATE                                                                     AMOUNT
  CREDIT UNION
  401k
  AUTO LOAN
  MORTGAGE OR RENT
  2ND MORTGAGE/HOME
  EQUITY
  ALIMONY/CHILD
  SUPPORT
  TOTAL INDEBTEDNESS
Note: If you have pledged your automobile as security it must be protected by comprehensive, fire & theft and collision insurance during the duration of the loan. IT IS YOUR RESPONSIBILITY
TO SECURE AND MAINTAIN the proper insurance coverage. Instruct your agent to send a loss payable clause in favor of FFCU.
I present the above information and the information truly and correctly stated to the best of my knowledge and for the purpose of obtaining credit from the Credit Union. I have no other debts.
I agree that the credit union is authorized to make inquiries pertaining to my employment, credit standing and financial responsibility.

SIGNATURE__________________________________________________DATE______                             SPOUSE SIGNATURE ____________________________________________DATE_____
ATTACH LISTING FOR ANY ADDITIONAL BILLS                                                           APPLICATION IS VOID AFTER 60 DAYS

				
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