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MEMBER LOAN APPLICATION
Applicant Information
First Name:
Middle Initial:
Last Name:
Social Security Number:
Date of Birth:
Number of Dependents:
Driver's License Number:
PO/Street Address:
Apt. No.:
Own   Rent  
Monthly Payment:
City:
State:
Zip:
How Long:
Home Phone:
Former Address if above address is less than 7 years:
City:
State:
Zip:
How Long:
Employment
Current Employer:
How Long:
Position/Title:
Monthly Salary:
Address:
City:
State:
Zip:
Work Phone:
Previous Employer/Address if current employer under 5 years:
How Long:
Co-Applicant Information
First Name:
Middle Initial:
Last Name:
Social Security Number:
Date of Birth:
Monthly Salary:
Home Phone:
Employer:
How Long:
Position/Title:
Work Phone
Address:
City:
State:
Zip:
Additional Income
Additional Source of Income
Monthly Amount:
Additional Source of Income
Monthly Amount:
Please return this application, a copy of the "Deed of Trust" for the home, and a copy of the contract(s) from contractor(s) to any local SSVEC office, or mail to: SSVEC; Attention: MEA; PO BOX 638; Sierra Vista, AZ 85636. If you have any questions, call the Marketing Department at (520) 515-3471 or 1-800-422-9288 ext. 3471.
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EUDC\Member Loans\Loan Application.dot
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References List Banks, Stores, Charge Cards, etc.
Account With
Address
Account Number
Balance Owing
Monthly Payment
Checking
Savings
Mortgage
Auto Loan
Auto Loan #2
Credit Acct. #1
Credit Acct. #2
Credit Acct. #3
Loan Amount / Purpose/ Incentive Information
Amount:
Purpose: Purchase and Installation of a New Heat Pump
Home Information:   New Home   Existing Home
Construction Year:
Square Footage:
Type:   Single Family   Multi Family   Manufactured Home   Commercial
Type of Cooling Being Replaced:   Central Air Conditioning   Heat Pump   Evaporative Cooler
  Other (specify) ____                           Sizeof replaced unit:
Type of Heating Being Replaced:   Resistance Electric   Heat Pump   Natural Gas Furnace   Propane Furnace
  Other (specify)                           Size of replaced unit:
The above information is correct and is given for the purpose of obtaining credit. You are authorized
to verify this information and to obtain additional information in reviewing this credit request.
Both Signatures are Required for a Joint Application
Applicant Signature
Joint Applicant Signature
Date
Date application received:_________
Account Number:___________
FOR SSVEC USE ONLY
Taken by:_______________
Premise Number:____________
Service established date:________
Cooperative Credit Rating:
___________ CDSW Rating:___________
Term Length (in months):__________
EEU 1 Billed 1st due 15th      
EEU 2 Billed 15th due 1st      
Has the applicant established credit as defined in the Cooperative's rules?
    YES
    NO
Other information or recommendations:
A loan of not more than
Recommended by:
will be available to this member.
Approved by SSVEC Cooperative Representative
Date
5/02
EUDC\Member Loans\Loan Application.dot
SMS-008