Mon – Thurs 9-4. Fri 9-6 585-567-4103 info@alleganyfirstfcu.com 27 West Main Street, Fillmore, NY 14735 More Contact Info

Allegany First FCU Loan Application

Individual Application

Joint Application

Would you like to purchase or refinance?*

Current Lender (if refinanced)

I own the collateral I am using to secure this loan (the collateral must be paid in full and have no liens against it).*

Yes

VIN #

Make

Model

Year

Mileage

Insurance Company*

Guaranteed Asset Protection (GAP) Insurance

GAP insurance is optional coverage that pays the difference between the actual cash value of your vehicle and the outstanding loan balance you owe in the event that your vehicle is declared a total loss following an accident or theft. It comes into play when your regular auto insurance payout doesn't fully cover the remaining amount you owe on your vehicle loan. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.

Do you want to add GAP insurance to you loan for a one-time fee of $188?

Yes, I want to add GAP insurance

No, I do not want to add GAP insurance

Repayment Method Payment Book
Automatic Transfer from your AFFCU Account
Savings Account
Checking Account

Loan Term (in months)

Payment Protection Coverage

Check coverage(s) desired. We will disclose the cost of this payment protection insurance - Credit Disability and Credit Life - to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.

Do you want your loan protected for you and your family in the event you become disabled?

Yes, I want my Loan Protected

No, I do not want my Loan Protected

Do you want your loan protected for you and your family in the event of your death?

Yes, I want my Loan Protected

No, I do not want my Loan Protected

Primary Applicant - Personal Information

First Name

Middle Initial

Last Name

Social Security No.

No dashes or spaces.

Driver's License No.

No dashes or spaces.

Driver's License State

Date of Birth

Address

Address 2

City

State

Zip Code

Years There

Phone (Best contact phone #)

No. of Dependents

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

Married

Separated

Unmarried (single / divorced / widowed)

Employment Information

Current Employer

Position

Annual Income

Employee Start Date

Previous Employer (if less than 2 years at present employer)

Start date

Other Income

Source

Credit Information

Residence

I own my residence

I rent my residence

I live with relatives

Present Mortgage Co., Landlord, or Relative

Monthly Mortgage/Rent Payment (includes taxes and insurance)

Reference

Name of nearest relative not living with you

Relatives Address

Address 2

City

State

Zip Code

Relationship

Phone

Additional Questions

Are you a US citizen or permanent resident alien?

Yes, I am a US Citizen or permanent resident alien

No, I am not a US Citizen or permanent resident alien

Do you have any outstanding judgments?

Yes, I have outstanding judgments

No, I do not have outstanding judgments

Is your income likely to decline in the next two years?

Yes, my income is likely to decline

No, my income is not likely to decline

Are you a co-maker, co-signer, or guarantor on any loan not listed?

Yes, I am a co-maker

No, I am not a co-maker

Have you ever had a car or other personal property repossessed by a dealer or finance company, filed for bankruptcy, or been a party to a wage assignment or collection suit, or have you ever been declined on a loan application with this credit union?

Yes

Joint Applicant - Personal information

First Name

Middle Initial

Last Name

Social Security No.

No dashes or spaces

Driver's License No.

No dashes or spaces

Driver's License State

Date of Birth

Address

Address 2

City

State

Zip Code

Years There

Phone (Best contact phone #)

No. of Dependents

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

Married

Separated

Unmarried (single / divorced / widowed)

Employment Information

Current Employer

Position

Annual Income

Employee Start Date

Previous Employer (if less than 2 years at present employer)

Start date

Other Income

Source

Credit Information

Residence

I own my residence

I rent my residence

I live with relatives

Present Mortgage Co., Landlord, or Relative

Monthly Mortgage/Rent Payment (includes taxes and insurance)

Reference

Name of nearest relative not living with you

Relatives Address

Address 2

City

State

Zip Code

Relationship

Phone

Additional Questions

Are you a US citizen or permanent resident alien?

Yes, I am a US Citizen or permanent resident alien

No, I am not a US Citizen or permanent resident alien

Do you have any outstanding judgments?

Yes, I have outstanding judgments

No, I do not have outstanding judgments

Is your income likely to decline in the next two years?

Yes, my income is likely to decline

No, my income is not likely to decline

Are you a co-maker, co-signer, or guarantor on any loan not listed?

Yes, I am a co-maker

No, I am not a co-maker

Yes

Terms and Conditions

Do you agree with the above terms and conditions?

Yes, I agree to the terms

No, I do not agree to the terms

Signature (type your full name)

Date

Co-Applicant

Do you agree with the above terms and conditions?

Yes, I agree to the terms

No, I do not agree to the terms

Signature (type your full name)

Date

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Allegany First FCU Loan Application

Primary Applicant - Personal Information

Employment Information

Credit Information

Reference

Additional Questions

Joint Applicant - Personal information

Employment Information

Credit Information

Reference

Additional Questions

Terms and Conditions

Office Hours

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