To: American Airlines Federal Credit Union
Member Name: Date of Birth:
Address: ZIP Code:
CHECK AS APPLICABLE
Applicant is applying for this loan:
o Individually, without a co-signer or guaranty of a person or other legal entity.
o Jointly, with the co-signature or guaranty of one or more persons or legal entities (including
existing guarantors).
Social Security Number Driver’s License Number Visa or Mastercard No. Home Phone
Occupation Name of Employer No. of Years Salary Business Phone
Amount of alimony, child support and separate maintenance payment income. NOTE: Alimony, child support or separate
maintenance payment income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Name and address of payer of any alimony, child support or separate maintenance payment income disclosed above as a source of repayment:
Alimony, child support, or separate maintenance received under:
o court order o written agreement o oral agreement o Other:
Income (salary, social security, dividend, interest, etc.) source: $ per month
Have you borrowed from any other branch of this Credit Union? Branch name: Date:
Number of dependents: Ages:
Have you established a trust?
o Yes o No If yes, is it: o Revocable o Irrevocable Name(s) of Trustee(s):
Have you made a will?
o Yes o No Name of Personal Representative:
Have you guaranteed or endorsed the notes and/or loans of any other person?
o Yes o No
Do you have any other contingent liabilities?
o Yes o No
Have any actions or suits been filed against you or are there any recorded judgments or decree entered against you or have you been adjudged bankrupt in
the last seven (7) years or made any assignments for the benefit of creditors?
o Yes o No
If yes, please explain:
Name of reference Address/Phone number
NAMES OF OTHER PERSON(S) OR LEGAL ENTITY(IES):
If applicant resides in a community property state, please complete the following concerning
marital status:
Applicant is: o married o separated o unmarried (includes single, divorced and widowed)
Co-Applicant, if any, is: o married o separated o unmarried (includes single, divorced and widowed)
Federally insured by NCUA
American Airlines Credit Union and the Flight Symbol are marks of American Airlines, Inc.
$
INDIVIDUAL FINANCIAL STATEMENT
1
10/15
$ per