Loan Application - Heartland Area Federal Credit Union

Important Information about applying for a loan

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask your name, address, date of birth, and other information that will allow us to identify you.

Step 1 of 6

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Your Personal Information

Your Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Your Email Address(Required)

Cell Phone(Required)

Work Phone

Best Time To Call You

When is the best time for us to reach you via telephone?

OK to Text?

Yes

Driver's License No.(Required)

Please provide you Driver's Lic#

State(Required)

Birth Date(Required)

MM slash DD slash YYYY

SSN / TIN(Required)

Please provide your SS# or your Tax ID#

Are you a U.S. citizen or permanent resident alien?(Required)

Yes

TIN CERTIFICATION AND BACKUP WITHHOLDING INFORMATION

Under penalties of perjury, I certify that:

The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued), and
I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service {IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
I am a U.S. citizen or other U.S. person. For federal tax purposes, you are considered a U.S. person if you are: an individual who is a U.S. citizen or U.S. resident al/en; a partnership, corporation, company, or association created or organized in the United States or under the laws of the United States; an estate (other than a foreign estate); or a domestic trust (as defined In Regulations section 301.7701-7).
The FATCA code(s) entered on this form {if any) indicating that I am exempt from FATCA reporting is correct. Certification Instructions. Cross out item 2 above If you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. Complete a W-8 BEN if you are not a U.S. person. If a W-8 BEN is completed, your signature does not serve to certify this section.

Loan Details

Purpose of Loan are you applying for?(Required)

Auto

Personal

Motocycle, Boat

Home Improvement

Debt Consolidation

Loan Amount Requested(Required)

Loan Amount Requested

Loan Term (months)(Required)

Do you currently have any outstanding judgements or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under Chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit?(Required)

Yes

Will you have a co-applicant

Yes

Employment Information

Current Employer(Required)

Please tell us where you are employed.

Employer Address(Required)

Street Address City State ZIP Code

Position(Required)

How long?

Monthly Income(Required)

Supervisor Name(Required)

First Last

Supervisor Phone(Required)

Is your income likely to decline in the next two years?(Required)

Yes

Are you a co maker,co signer, or Guarantor on any loan not listed?(Required)

Yes

Co Applicant Information

Co Applicant Name(Required)

First Last

Co Applicant Address(Required)

Street Address City State ZIP Code

Co Applicant Email Address

Co Applicant Cell Phone

Co Applicant Work Phone

Co Applicant SSN / TIN(Required)

Please provide your SS# or your Tax ID#

Co Applicant Driver's License No.(Required)

Please provide you Driver's Lic#

Co Applicant State

Co Applicant Birth Date(Required)

MM slash DD slash YYYY

Credit Information

Have you previously taken a loan from any financial institution?

Yes

(1) Loan Institution(Required)

(1) Loan Purpose(Required)

(1) Balance(Required)

(2) Loan Institution

(2) Loan Purpose

(2) Balance

(3) Loan Institution

(3) Loan Purpose

(3) Balance

Have you ever defaulted on a loan?

Yes

Please provide details(Required)

Credit Obligations, please list

Do you have a Credit Card?

Yes

(1) CC# (last 4 digits)(Required)

(1) CC# Balance(Required)

Do you have a 2nd Credit Card?

Yes

(2) CC# (last 4 digits)

(2) CC# Balance

Do you own or rent?(Required)

Homeowner

Rent

Monthly House Payment(Required)

Monthly Rent Amount(Required)

Please include two (2) Personal References

Personal Reference #1 (Full Name)(Required)

Reference #1 Phone(Required)

Personal Reference #2 (Full Name)(Required)

Reference #2 Phone(Required)

I Agree(Required)

By signing below, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-inSavings Disclosure, Funds Availability Policy Disclosure. if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein. I/We acknowledge receipt of a copy of the agreements and disclosures applicable to the accounts and services requested herein. If an access card or EFT service is requested and provided, I/we agree to the terms at and acknowledge receipt of the Electronic Fund Transfers Agreement and Disclosure. The Internal Revenue Service does not require your consent to any provision of this documents other than the certifications required to avoid backup withholding.

By submitting this Loan Application online, I agree to receive all required disclosures electronically.

Please Note:

In an effort to keep your personal information confidential, we will not be storing any information entered into any of the above applications after the application has been inactive for more than 15 minutes. Because you will have to start the application from the beginning after the 15 minutes of inactivity, please plan accordingly when you are completing an application.

Important Information about applying for a loan

Your Personal Information

TIN CERTIFICATION AND BACKUP WITHHOLDING INFORMATION

Loan Details

Employment Information

Co Applicant Information

Credit Information

Credit Obligations, please list

Please include two (2) Personal References

Please Note:

Branch Locations

NEW Hours (effective Jan. 1, 2024)

Get the mobile App!

Membership and Account Agreement | Truth-in-Savings Account Disclosures | USA Patriot Act | Privacy Policy

Branch Locations

NEW Hours

Get the mobile App!

Membership and Account Agreement | Truth-in-Savings Account Disclosures | USA Patriot Act | Privacy Policy

Branch Locations

Get the mobile App!

NEW Hours

Membership and Account Agreement | Truth-in-Savings Account Disclosures | USA Patriot Act | Privacy Policy

Main Branch		Southwest Branch
6111 N. 72nd Street Omaha, NE 68134-2157		11117 John Galt Blvd. Omaha, NE 68137
Phone (402) 571-8444		Phone (402) 339-6755

Main Branch		Southwest Branch
6111 N. 72nd Street Omaha, NE 68134-2157		11117 John Galt Blvd. Omaha, NE 68137
Phone (402) 571-8444		Phone (402) 339-6755

Main Branch		Southwest Branch
6111 N. 72nd Street Omaha, NE 68134-2157		11117 John Galt Blvd. Omaha, NE 68137
Phone (402) 571-8444		Phone (402) 339-6755