Branch 6000 Credit Union

(631) 789-0303 | 630 Broadway Amityville, NY 11701 | M&Th: 11am-4pm Tu&W: 11am-7pm F: 10am-1pm | info@branch6000cu.com

Single Application

Joint Application

Credit Limit Requested

Primary Card Holder

First Name

Middle Initial

Last Name

Account Number

Social Security No.

Date of Birth

Phone (Best contact phone #)

Business Phone

Driver's License No.

Driver's License State

Ages of Dependents

Address

Address 2

City

State

Zip Code

Years There

I own this property

I rent this property

Previous Address (if less than 2 years at present address)

Address 2

City

State

Zip Code

Years There

I own this property

I rent this property

Present Mortgage Co., Landlord, or Relative

Monthly Mortgage/Rent Payment (includes taxes and insurance)

Mortgage Balance

Interest Rate

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

Married

Separated

Unmarried (single / divorced / widowed)

Employment Information

I work full time

I work part time

Current Employer

Start date

Employee Address

Address 2

City

State

Zip Code

Annual Income

Position

Other Income

Source

Previous Employer (if employed less than 5 years)

Employee Address

Address 2

City

State

Zip Code

Start date

End date

Military

I expect duty station transfer during the next year

I do not expect duty station transfer during the next year

Where

End / Separation Date

Do you have any outstanding judgments?

Yes, I have outstanding judgments

No, I do not have outstanding judgments

Have you filed for bankruptcy?

Yes, I have filed for bankruptcy

No, I do not have not filed for bankruptcy

Co-Applicant

First Name

Middle Initial

Last Name

Account Number

Social Security No.

Date of Birth

Phone (Best contact phone #)

Business Phone

Driver's License No.

Driver's License State

Ages of Dependents

Address

Address 2

City

State

Zip Code

Years There

I own this property

I rent this property

Previous Address (if less than 2 years at present address)

Address 2

City

State

Zip Code

Years There

I own this property

I rent this property

Present Mortgage Co., Landlord, or Relative

Monthly Mortgage/Rent Payment (includes taxes and insurance)

Mortgage Balance

Interest Rate

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

Married

Separated

Unmarried (single / divorced / widowed)

Employment Information

I work full time

I work part time

Current Employer

Start date

Employee Address

Address 2

City

State

Zip Code

Annual Income

Position

Other Income

Source

Previous Employer (if employed less than 5 years)

Employee Address

Address 2

City

State

Zip Code

Start date

End date

Military

I expect duty station transfer during the next year

I do not expect duty station transfer during the next year

Where

End / Separation Date

Do you have any outstanding judgments?

Yes, I have outstanding judgments

No, I do not have outstanding judgments

Have you filed for bankruptcy?

Yes, I have filed for bankruptcy

No, I do not have not filed for bankruptcy

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