I am interested in (CHECK ALL THAT APPLY):
Loan Amount $ Purchase Re-finance Home Equity Home Improvement Borrower:  SSN#:  DOB:  Co-Borrower:  SSN#:  DOB:  Address:  City:  State:  Zip:  Home Phone:  Cell Phone :  Email:  Borrower's Employer:        Yrs Employed Work Phone :
Rent $ /month Own $ /month Borrower's Gross Monthly Income:  Co-Borrower's Gross Monthly Income:  Total Amount Paid Monthly on Open Accounts:  General Authorization This authorizes America's Credit Union, and its assigns, to verify my/our past and presnt employment, earnings records, bank accounts, stock holdings and any other balances needed to process my application. This further authorizes America's Credit Union to order a credit report and verify all other information, including past or present mortgage and landlord references. It is understood that a photocopy of this document shall also serve as an authorization to provide the information for a loan application.
Borrower's Signature:______________________________________  Date ___________ Co-Borrower's Signature:_________________________________________ Date: ____________