Loan Application
Diversified General FCU
631 E Broadway, Logansport, IN 46947
Phone:574-753-3547, Fax:574-753-8501

You are submitting this LoanApp from IP Address: 3.141.19.249

We strongly recommend that you print this page after completing it, but before submitting it.

Applicant Information:
* Required Fields

* Member Number:
if not a member put NONE

* SSN: - - * DOB: / /
* First, Middle, Last Name:
* Email Address:
Marital Status:
(Complete marital status if this loan is for: Joint or secured credit, or you reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)  
Loan Information: Tell us about the type of loan you want. 
Will there be a Co-Applicant on this application? If Yes select the Co-Applicant Type?
*Type of Loan Requested:     
I agree to the Terms/Conditions of the Disclosure
If Vehicle, Boat, Motorcycle Loan, Please indicate Purchase Type?
*Loan Amount Requested:   $

*Loan Term Requested:

Payment Amount Requested:   $ please provide if you would like a specific monthly payment.  
Are you interested in Credit Life and/or Disability Insurance? This type of insurance protects your family and your credit rating if you cannot repay your loan due to illness, disability, or loss off life. Learn More...
Vehicle/Collateral Information: If this loan is for any type of auto, motorcycle, ATV, camper, RV, motorhome, etc. please provide the details.
Vehicle Type?
Year
Make
Model
VIN
Odometer
Other Collateral / Description:
Are you interested in GAP Protection? GAP protection will insure one for the difference between what one would owe on a vehicle and what an insurance company says it's worth. This insurance is a must for someone who is considering purchasing a new vehicle since a new vehicle depreciates right after it is driven off the dealer's lot. Learn More...

I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Credit Union, information concerning me or my affairs. (Sec. 1014, Title 13, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.) Income verification is required. Other information may be required. Loan Approval and Interest Rate is determined by your credit history. By clicking the submit button below, I hereby apply for credit with your credit union. Further, I agree to and accept the terms of the Disclosure.

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. This policy is in compliance with the USA PATRIOT Act's Customer Identification Policy (CIP). In opening the account, the person will be asked for the following information: name, date of birth, street address, and identification number. Documents that will be accepted for verification of identity include current/active government-issued identification bearing a photograph, such as a driver's license or passport, social security card, or worker ID. We will also verify identification by calling ChexSystems or running a credit report.