Heritage Grove Federal Credit Union

Vehicle Loan Application

Personal Information

   1.  Social Security #: ______-____-________    2. BirthDate: ____ (month) ____ (day) ________ (year)

   3.  First Name: _______________  Last Name: _______________   M.I: ____

   4.  Home Phone: ( ___ ) _____ - _______  Work Phone: ( ___ ) _____ - _______  Extension: ________

Address Information

   5. Address: ________________________________________________________________________

       City: ________________  State: ____  Zip: __________ - ________
    
       Occupancy Status (choose one only): Own Rent Live with Parents Other: _____________

       Occupancy Duration: ____ years

Employment Information

   6.  Occupation: ____________  Employer: ____________ Employment Duration: ___ years ___ months

   7.   Total Monthly Income: $_____________  
  Total Monthly Payment: $_____________ (ie: credit card bills, car payments, loan payments)
  Monthly Housing Cost: $_____________ (ie: Rent, Mortgage Payment)

Vehicle Information

   8.  Make: ____________  Model: _____________  Year:  ______  Condition:  New  Used

        Estimated Vehicle Value: ___________  Down Payment: _____________  Term: _______ months

Co-Applicant Personal Information

  9.  If there is a co-applicant, please specify: ___ Joint  ___ Independent 

 10.  Social Security #: ______-____-________     11. BirthDate: ____ (month) ____ (day) ________ (year)

 12.  First Name: _______________  Last Name: _______________   M.I: ____

 13.  Home Phone: ( ___ ) _____ - _______  Work Phone: ( ___ ) _____ - _______  Extension: ________

Co-Applicant Address Information

 14.  Address (if different from applicant): _______________________________________________________

        City: ________________  State: ____  Zip: __________ - ________
    
        Occupancy Status (choose one only): Own Rent Live with Parents Other: _____________

        Occupancy Duration: ____ years




Heritage Grove Federal Credit Union
631 Winter Street NE
Salem, OR  97301
Phone: 503-588-0211
Fax: 503-485-2139