Gabriels Community Credit Union Online Loan Application     Please fill out all fields as completely as possible so as not to delay processing

Purpose of Loan:                 Term: 1 Year 2 Year 3 Year 4 Year 5 Year 7 Year 10 Year 15 Year 20 Year 30 Year Account Number: Amount Requested This application  initiates the loan process.  Final signature(s) will be required to advance funds. PLEASE TELL US ABOUT YOURSELF (PRIMARY BORROWER) Full Name Street Address City, State  Zip Years There Home Phone Work Phone Driver's License State/Number:    Social Security Number Birth Date E-Mail Address PLEASE TELL US ABOUT YOUR JOB (PRIMARY BORROWER) Current Employer Years There Phone Number Position Gross Monthly Income alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation Other Income Source The following information pertains to CO-BORROWER. If there is not a CO-BORROWER, click here to continue. PLEASE TELL US ABOUT YOURSELF (CO-BORROWER) Full Name Home Address City, State  Zip Years There Home Phone Social Security Number Birth Date PLEASE TELL US ABOUT YOUR JOB (CO-BORROWER) Current Employer Years There Phone Number Position Gross Monthly Income alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation Other Income Source PLEASE LIST NEAREST RELATIVE NOT LIVING WITH YOU Full Name Home Address City, State  Zip Phone Number IF APPLYING FOR A PERSONAL UNSECURED LOAN SUCH AS VACATION OR OTHER PLEASE SELECT A FORM OF COLLATERAL Collateral: Vehicle Paid in Full CD Deposit Account Home Other MONTHLY PAYMENTS Debt Payments Payment to Monthly Payment Balance Owed Mortgage  or Rent Auto: Charge Card: $ Amount you pay in alimony or child support alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation Are you a Co-Borrower on any other loans?  Yes No For Whom: Where: Monthly Payment: Click the "I accept the terms of the disclaimer above and submit my application" button to send the application to us via the WWW after reading the disclaimer below.  By clicking "I accept the terms of the disclaimer above and submit my application", you accept the terms of the disclaimer below. DISCLAIMER:  I/WE HEREBY CERTIFY THAT ALL STATEMENTS MADE ARE TRUE AND COMPLETE, ARE SUBMITTED FOR THE PURPOSE OF OBTAINING CREDIT, AND THAT THE CREDIT UNION MAY RELY ON THEM FOR SUCH DETERMINATION.  I/WE AUTHORIZE YOU TO OBTAIN SUCH INFORMATION AS YOU MAY REQUIRE CONCERNING THE STATEMENTS MADE IN THIS APPLICATION, AND AGREE THAT THE APPLICATION SHALL REMAIN YOUR PROPERTY, AND YOU ARE AUTHORIZED TO ANSWER QUESTIONS ABOUT YOUR CREDIT EXPERIENCE WITH ME/US. Signature: _________________________________Date: _______________________

Gabriels Community Credit Union
1901 E. Michigan Avenue
Lansing, Michigan 48912
(517) 484-0601
Fax: (517) 484-1448
dand@gabrielscu.com