List comments or special instructions in the area provided below. If you are applying for Joint credit, please type the name of the person you are applying with on box below.

The following information 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, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not with to furnish this information, please check the box below.

The following information 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, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not with to furnish this information, please check the box below.

If you answer "yes" to any of the following questions, please explain.

The applicant whose name appear on this application certifies that the information submitted herein is true and complete. The applicant authorizes the Credit Union to obtain information as it may require concerning the statements made in this application including credit reports and employment history and to provide information to others about Credit Union's credit experience with the applicant. The Credit Union may retain this application whether or not it is approved.