carolinacu.com Referring Credit Union Employee Last 4 of Member Number First Name Middle Name Last Name Address Line 1 Address Line 2 City State Zip Code Years at Address Mother's Maiden Name Marital Status  Daytime Phone () - Evening Phone () - E-mail Address Comments Loan Purpose Amount Requested Current Employer Position Length of Employment Salary Monthly Mortgage or Rent Payment Auto Loan Payment #1 Auto Loan Payment #2 Credit Card Payment #1 Credit Card Payment #2 Credit Card Payment #3 Any Other Debt #1 Any Other Debt #2 Any Other Debt #3 Any Other Debt #4 By clicking submit you agree: Should there be any important changes you will notify us in writing. You also agree to notify us of any change of address, name or employment within a reasonable time thereafter. You agree that everything that you have stated in this application is accurate to the best of your knowledge and the above information is a complete listing of all your debts and obligations.