Medical Community Credit Union is committed to serving its members' financial needs by providing the ultimate in services. 

 


On-Line LOANLINER Loan Applications

LoanLiner Submission:  Applicants may elect to print
form out, sign, and mail in to Medical Community CU.
Security Notice:  This LoanLiner Application is 
protected on a secured site.
All data entered is encrypted, once completed the form is 
sent to Medical Community CU where it is processed.

 

®

LOAN REQUEST

Medical Community Credit Union
1144 S. Clifton
Wichita, KS  67218-2913

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Married applicants may apply for a separate account.  
If you are applying for Individual Credit, you
must complete the Applicant section about yourself and the 
Co-Applicant
section about your spouse if:

  1. You live in or the property pledged as collateral is located in a community 
    property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI), Your spouse will 
    use the account, or You are relying on your spouse's income as a basis for 
    repayment.

If you are relying on income from alimony, child support or separate 
maintenance, complete the Co-Applicant section to the extent possible 
about the person on whose payments you are relying.

If you are applying for Joint Credit with another person, complete the 
Applicant
and Co-Applicant sections.

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TYPE AND AMOUNT OF CREDIT YOU'RE REQUESTING

Is this your first loan from us? yes no
Amount/Credit Limit Requested: $
Approximate Time to Repay: How Many?       Periods:
Loan Type:
Security Offered:
( For secured credit only )
Type of Credit: Individual Joint

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PAYMENT PROTECTION COVERAGE Check if desired

Find out more about Payment Protection Insurance and why it's a better 
consumer  value when offered through your credit union.

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.

Yes No Do you want your loan protected for you and your family if you 
become disabled?
Yes No Do you want your loan protected for you and your family in the 
event of your death?

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TELL US ABOUT YOURSELF

E-Mail:
Applicant Co-Applicant
Name: Name:
CU Account #: CU Account #:
Social Security #: Social Security #:
Please indicate your marital status if you 
are applying for Joint Credit, Secured 
Credit or if you live in a community 
property state:
Married Separated Unmarried 
                     (Single - Divorced - Widowed)
Please indicate your marital status if you 
are applying for Joint Credit, Secured 
Credit or if you live in a community 
property state:
Married Separated Unmarried 
                      (Single - Divorced - Widowed)
Driver's License #:
State:
Driver's License #:
State:
Birth Date: Birth Date:
Home Phone:
Business Phone:
Home Phone:
Business Phone:
Present Address:
Years There: Own Rent
Present Address:
Years There: Own Rent
Job Title: Job Title:
ETS Date: ETS Date:
DEBTS DEBTS
Mortgage/Rent owed to: Mortgage/Rent owed to:
Balance (Mortgage only): Balance (Mortgage only):
Monthly Payment:
Current APR % (Mortgage only):
Monthly Payment:
Current APR % 
(Mortgage only):
Person Responsible for Payment: Person Responsible for Payment:
INCOME INCOME
Employer: Employer:
Income: $ Net Gross
Annual Monthly Bi-weekly Weekly
Income: $
Net Gross
Annual Monthly Bi-weekly Weekly
Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)
Source:
$ Annual MonthlyHourly
Other Income: (Notice: Alimony, child support or separate maintenance income need 
not be revealed if you do not have it considered 
as a basis for repaying this obligation.)

Source:
$ Annual MonthlyHourly

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NOTICE TO OHIO RESIDENTS: The Ohio laws against discrimination 
require all creditors make credit equally available to all credit worthy 
customers, and that credit reporting agencies maintain separate credit 
histories on each individual upon request. 
The Ohio Civil Rights Commission administers compliance with this law.

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SIGNATURES: You promise that everything you have stated in this request 
is correct to the best of your knowledge. If there are any important changes, 
you will notify us in writing immediately.
You also agree to notify us of any change in your name, address or 
employment  within a reasonable time thereafter. You authorize the credit 
union to obtain credit reports in connection with this request.
If you request, the credit union will tell you the name and address of any 
credit bureau from which it received a credit report on you. You understand 
that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on requests made to Federal Credit Unions or State Chartered Credit Unions insured by the NCUA. You understand that the credit union will rely on the information in the request and 
your credit report to make its decision.

X________________________________
Applicant Signature and Date
X________________________________
Co-Applicant Signature and Date

Applicants may elect to print form out, sign, and mail in to Medical Community CU.

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By submitting this loan request, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment.

You authorize the credit union to obtain credit reports in connection with this request.


©CUNA MUTUAL INSURANCE SOCIETY, 1980, 82, 84, 86, 89. ALL RIGHTS RESERVED

CSTLR1 6857 - Internet Loan Request


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Medical Community Credit Union
1144 S. Clifton
Wichita, Kansas  67218
800.888.4101

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