NOTEWORTHY FCU                                                                                                                                              Loan Application
1900 Superior Avenue Suite #126
Cleveland, OH 44114
(216)263-7034

Loan Amount Requested $ _____________________________

Purpose of Loan: _____________________________________

Collateral: ______________________________ Account # ______________

Term of Loan: 12 Month ____ 24 Month ____ 36 Month ____ 48 Month ____ 60 Month ____ Other ________

Name: ______________________________

Address: _________________________________________

City: _______________ State: _____ Zip: __________

Phone: (hm) (____) ____________ (wk) (____) ____________ (cell) (____) ____________
Social Security No: _______________ Date of Birth: ___/______/_____

Employer: _________________________

Employment Date: __________ Monthly Gross Income $: ___________

*Other Income $: ___________ Employer: __________

(Please attach proof of income)
(Please note, if you are applying for credit in your name only-DO NOT complete this portion for Co-Applicant.)

Spouse's Name: ______________________________

Phone: (hm) (____) ____________ (wk) (____) ____________ (cell) (____) ____________
Social Security No: _______________ Date of Birth: ___/______/_____

Employer: _________________________

Employment Date: __________ Monthly Gross Income $: ___________

*Other Income $: ___________ Employer: __________

(Please attach proof of income)

*Alimony, child support or separate maintained income need not be revealed if you do not wish to have it considered as a basis for repaying this loan

Outstanding Obligations
                                                       CREDITOR                            BALANCE                            MONTHLY PAYMENT             
Mortgage/Rent:      
Auto:      
Bank:      
Credit Card:      
Dept. Store:      
Credit Union      
Student Loan      
    TOTAL -------->  
Failure to list all credit obligations can result in denial of this loan! Please list any additional loans/obligations on the back of this sheet.

REFERENCE:
            Name: ______________________________________ Address: __________________________________________________

            Relationship: ____________________ Phone#: ____________________ City: ________________ State: ____ Zip: ________

Your Signature Below gives us permission to request information from any credit agency we deem necessary to grant credit:

Signature: ______________________________________ Spouse's Signature: ______________________________________

    Date:____________________                                                     Date:____________________

The Ohio Laws against discrimination require that all creditors make credit available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio civil rights commission administers compliance with this law.)

The Following items are needed when applying for a loan with NoteWorthy FCU:

1. $30.00 Loan Application Fee (non-refundable)                                      3. $250.00 Pledge Shares in the share account at the time of approval
    $15.00 Lien Fee for a lien on a title or memo.                                              (revolving 10% of amount borrowed)
    $15.00 Lien Fee for a lien on an instrument.                                           4. Verification of income must be submitted with loan application
2. $20.00 Application Fee for Co-Signers (non-refundable)                              Co-Signer must also submit Proof of Income.