Heartland Area Federal Credit Union Loan Application
All information submitted to Heartland Area Federal Credit Union is transmitted through a secure server.
Privacy Statement

Applicants Statement

Membership Number
Is This Your First Loan With Us?
Individual Credit
(Married applicants may apply individually)
Joint Credit
(Both of you must complete this application)

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

Marital Status
Amount Requested
Length of Loan Requested
Purpose of Loan
Collateral Offered

Credit Insurance
Check coverage (s) desired. We will disclose the cost of voluntary insurance. A separate enrollment form must be signed before the coverage can become effective.

Single Credit Disability

Joint Credit Disability

Applicant's Statement

Name

Current Address

City

State

ZIP

Date of Birth

Number of Dependents (exclude self)

Business Phone (Include Area Code)

Home Phone (Include Area Code)

SSN

Email Address

Employment

Employed By

Business Address

City

State

ZIP

Date Employed

Position

Gross Income

Gross Income Shown Above Is

Business Phone

Previous Employer
Position
How Long

Nearest Relative (Not living with you)

Name

Address

City

State

ZIP

Phone

Relationship

Other Income
Notice: Alimony, Child Support or separate  maintenance income does not need to be revealed 
if you do not wish to have it considered as a basis for repaying this loan.)

Other Income

Source

Amount

Per

Outstanding Debt
(Include Charge Accounts, Installment Contracts, Credit Cards, Rent, Mortgages, Alimony, 
Child Support, Separate Maintenance, Student Loans, etc.)

Please Fill In All Applicable Areas

Home

Mortgaged

Landlord

Monthly Payment or Rent

Mortgage Balance

Automobiles

Auto Make

Year

Mo. Payment

Balance Due

If Financed, By Whom

Auto Make

Year

Mo. Payment

Balance Due

If Financed, By Whom

Other Obligations

Owed To

Balance

Payment

Owed To

Balance

Payment

Owed To

Balance

Payment

Owed To

Balance

Payment

Owed To

Balance

Owed To

Please Answer the Following Questions.
If you answer "Yes" to any questions please explain in the comments section provided below.

Are there any judgments, garnishments, or legal proceedings against you?

Have you ever been through bankruptcy?

If yes, what year?

Are you a co-maker, endorser, or guarantor for any loans not shown on this application?

Comments:

Co-Applicant

Name

Relationship to Applicant

SSN

HAFCU Account Number

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

Number of Dependents

Business Phone (Include Area Code)

Home Phone (Include Area Code) 

Current Address

City

State/Zip

Years There

Do You

Name of Employer

Address of Employer

Gross Income

Gross Income Shown Above Is:

Other Income
Notice: Alimony, Child Support or separate  maintenance income does not need to be revealed 
if you do not wish to have it considered as a basis for repaying this loan.)

Other Income

Source

Amount

Per

Outstanding Debt
(Include Charge Accounts, Installment Contracts, Credit Cards, Rent, Mortgages, Alimony, 
Child Support, Separate Maintenance, Student Loans, etc.)

Please Fill In All Applicable Areas

Home

Mortgaged

Landlord

Monthly Payment or Rent

Mortgage Balance

Automobiles

Auto Make

Year

Mo. Payment

Balance Due

If Financed, By Whom

Auto Make

Year

Mo. Payment

Balance Due

If Financed, By Whom

Other Obligations

Owed To

Balance

Payment

Owed To

Balance

Payment

Owed To

Balance

Payment

Owed To

Balance

Payment

Owed To

Balance

Owed To

Please Answer the Following Questions.
If you answer "Yes" to any questions please explain in the comments section provided below.

Are there any judgments, garnishments, or legal proceedings against you?

Have you ever been through bankruptcy?

If yes, what year?

Are you a co-maker, endorser, or guarantor for any loans not shown on this application?

Comments:

Tell us how to get in touch with you:

Name

E-mail

Phone

Fax:

This form can be printed and faxed to Heartland Area Federal Credit Union at (402) 571-0462

For Dwelling or Real Estate-Related Loans ONLY:
The information at the following link is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with Equal Credit Opportunity and Fair Housing laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may neither discriminate on the basis of this information, nor on whether you chose to furnish. However, if you choose not to furnish the information, under federal regulations the lender is required to note race or national origin and  sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.
"I wish to furnish equal credit opportunity/fair housing monitoring information."

I do not wish to furnish this information:

Acknowledgment:
Both the applicant and the co-applicant agree that: By submitting this application I promise that everything I have stated is correct to the best of my knowledge. I agree to notify HAFCU of any important changes to this application, including name or address change. I authorize HAFCU to obtain credit reports, check employment and income, or make other reasonable inquiries in connection with this application. I understand that HAFCU will rely on this information in making its credit decision, and I understand that it is a federal crime to willfully and deliberately provide false or misleading information to a federally insured financial institutions. 
All information submitted to Heartland Area Federal Credit Union will be kept confidential.

The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applications on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of that applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal Agency that administers compliance with this law concerning this creditor is:

Consumer Response Center
Federal Trade Commission
Washington, DC 20580
or
Department of Justice
Civil Rights Division
Washington, DC 20530 

Heartland Area Federal Credit Union
6111 N. 72nd Street Omaha, NE 68134-2157
Toll Free 1-866-314-2328
(402) 571-8444 Fax: (402) 571-0462


Your savings Federally insured to at least $250,000
and backed by the full faith and credit of the United States Government.
National Credit Union Administration,
a U.S. Government Agency.


We do business in accordance with the
Federal Fair Housing Law and the
Equal Credit Opportunity Act.

Copyright 2000
Heartland Area Federal Credit Union
All rights reserved
Revised: October 21, 2008