BSE Loan Application

Please complete the information on this application to apply for any type of loan. All information is required in order to process your application.

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After you have completed the form, press the "Submit Application" button to send your application. Our website is protected by the VeriSign, an internet security provider.

Once your application is received at the credit union, a Loan Officer will contact you for additional information. Income verification will be required. 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.

Online Loan Application Required Field Select Individual Joint Will you be applying for Individual or Joint Credit? If applying for joint credit, please read below to verify that you intend to apply for joint credit: By checking this box, I acknowledge that I'm the joint applicant on this loan application. Select Unmarried Married Separated Martial Status:  Complete marital status if this loan is for joint or secured credit.   Applicant Information Purpose for the Loan Amount Requested Last Name   First Name   Initial Social Security Number Birthdate 00/00/19?? Home Phone w/Area Code   Driver's License # Current Home Address   City   State   Zip Code   Select Own Rent Own/Rent Monthly Rent/Mortgage Years at Address Previous Address (If less than 5 years at current residence.) Length of Time Previous Home Address City State Zip Code Number of Dependents E-mail Address (Required)   Please list one personal reference (can be a family member) who does not live with you. Name Relationship   Phone No. Address City State Zip Code Do you have a Savings Account? Select Yes No   If yes, where? Savings Account Number Do you have a Checking Account? Select Yes No   If yes, where? Checking Account Number Select Yes No Are you a U.S. Citizen or permanent alien?       Select Yes No Do you currently have any outstanding judgments or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under Chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit?   Select Yes No Is your income likely to decline in the next two years?     Select Yes No Are you a co-maker, co-signer or guarantor on any loan not listed above?     If yes, list the name of others obligated on loan and the name of the creditor.   Select Yes No Are you responsible for alimony or child support? Alimony or child support does not need to be disclosed if it is not applicable to this loan application.     Employer Information (Applicant) Employer Name Position Hire Date Employer Address Work Phone w/Area Code City State Zip Code Monthly Gross Wages Other Income & Source Supervisor's Name Previous Employer How long at previous employer? Position   Co-Applicant Information Last Name First Name Initial Social Security Number Birthdate 00/00/19?? Home Phone w/Area Code Driver's License #       Current Home Address City State Zip Code Select Own Rent   Own/Rent Monthly Rent/Mortgage Years at Address Previous Address (If less than 5 years at current residence.) Previous Home Address City State Zip Code Number of Dependents E-mail Address (Required)   Please list one personal reference (can be a family member) who does not live with you.  Name Relationship Phone No. Address City State Zip Code Do you have a Savings Account? Select Yes No   If yes, where? Savings Account Number Do you have a Checking Account? Select Yes No   If yes, where? Checking Account Number Select Yes No Are you a U.S. Citizen or permanent alien?     Select Yes No Do you currently have any outstanding judgments or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under Chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit?    Select Yes No Is your income likely to decline in the next two years?    Select Yes No Are you a co-maker, co-signer or guarantor on any loan not listed above?    If yes, list the name of others obligated on loan and the name of the creditor.     Select Yes No Are you responsible for alimony or child support?         Employer Information (Co-Applicant) Employer Name Position Hire Date Employer Address Work Phone w/Area Code City State Zip Code Monthly Gross Wages Other Income & Source Supervisor's Name Previous Employer How long at previous employer? Position   I hereby authorize the Credit Union to whom this application is made, or any Credit Bureau or other investigative agency employed by such Credit Union, to investigate the references herein listed or statements or other data obtained from me or from any other source whatsoever pertaining to my credit and financial responsibility. The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.