Online Loan Application – Casebine Community Credit Union

(800) 242-3476

info@casebine.com

Routing: 273972761

This form is NOT for mortgage or home equity loans. Please visit a branch if you are looking for a mortgage or home equity loan.

Step 1 of 10

10%

Applying as Individual or Joint?*
- Individual
- Joint
Marital Status*
Complete marital status if this loan is for:
a. Joint or secured credit, or
b. You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)
- Unmarried
- Married
- Separated
- This application is not for joint or secured credit and I do not live in the states listed above.
Type of Loan Requested*
Loan Amount Requested*
Loan Term Requested*
Description
Make / Model, VIN #, etc

Your Basic Information
Casebine Member Number
Name*
First Middle Last
Social Security Number*
Date of Birth*
Primary Phone Number*
Secondary Phone Number
Your Email
Enter Email Confirm Email
Driver's License / State ID*
Number Issuing State
Driver's License / State ID Expiration*
Date Format: MM slash DD slash YYYY

Current Address
Your Current Home Address*
Street Address Address Line 2 City State ZIP Code
Time at Current Residence*
Residence Type*
- Own
- Rent
Monthly Payment*
Previous Address
Previous Address*
Street Address Address Line 2 City State ZIP Code
Time at Previous Residence*
Previous Residence Type*
- Own
- Rent

Co-Applicant Basic Information
Casebine Member Number
Name
First Middle Last
Social Security Number
Date of Birth
Primary Phone Number
Secondary Phone Number
Email
Enter Email Confirm Email
Driver's License / State ID
Number Issuing State

Co-Applicant Current Address
Current Address
Same as Borrower?

Street Address Address Line 2 City State ZIP Code
Time at Current Residence
Residence Type
- Own
- Rent
Monthly Payment
Co-Applicant Previous Address
Previous Address
Street Address Address Line 2 City State ZIP Code
Time at Previous Residence
Residence Type
- Own
- Rent

Reference (Please Include 2)
Nearest relative not living with you.
Name*
First Last
Relationship to You*
Address*
Street Address Address Line 2 City State ZIP Code
Primary Phone Number*
Second Reference Name
First Last
Second Reference Relationship to You
Second Reference Address
Street Address Address Line 2 City State ZIP Code
Second Reference Primary Phone Number

Debts / Monthly Payments
List
Name Payment Amount

Additional Info
How would you prefer to be contacted?*
- Primary Phone
- Secondary Phone
- Email
Other questions or comments?
Submit Loan Application
Income verification is required; other information may be required.
Confirm Submission*
- I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Financial Institution, information concerning me or my affairs.(Sec. 1014, Title 18, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.)

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CCCU Routing #: 273972761 | CCCU NMLS #: 440074