Secure Loan Application
501 Industrial Highway, Ridley Park, PA 19078
Phone: (610) 595-2929  •  Fax: (610) 595-2933
Account Number - You Must Be A Member Amount Requested Type Of Loan Applying For Term
$ Months
Reason For Loan:
This Loan Is For:
If Applying For A Home Equity Loan Please Answer The Following Questions:
INFORMATION FOR GOVERNMENT MONITORING PURPOSES

NOTICE: Complete only if this is a Home Improvement Loan or if you are applying to purchase or refinance your residence.

The following information is requested by the Federal Government for certain types of loans related to a dwelling, in order to monitor the Lenders’ compliance with equal credit opportunity and fair housing laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a Lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it under Federal regulations this Lender is required to note race and sex on the basis of visual observation surname. If you do not furnish the above information, please check the box below.

BORROWER CO-BORROWER
I do not wish to furnish this information. I do not wish to furnish this information.
   
Race/National Origin Race/National Origin
American Indian or Alaskan Native American Indian or Alaskan Native
Asian Asian
Black or African American Black or African American
Native Hawaiian or other Pacific Islander Native Hawaiian or other Pacific Islander
White White
Other (Specify) Other (Specify)
   
Ethnicity Ethnicity
Hispanic or Latino Hispanic or Latino
Not Hispanic or Latino Not Hispanic or Latino
   
Sex:     Male      Female Sex:     Male      Female
 

PRIMARY APPLICANT
 
CO-BORROWER

Name: First, Middle, Last

Name: First, Middle, Last
Social Security Number:
Date of Birth:
 
Social Security Number:
Date of Birth:
What Is Your Email Address?
  What Is Your Email Address?
Home Phone Number:
Cell Phone Number:
I Can Be Best Reached Via:

 
Home Phone Number:
Cell Phone Number:
I Can Be Best Reached Via:

What Is Your Home Address?
Street: City:
  What Is Your Home Address?
Street: City:
State: Zip:
 
State: Zip:
Monthly Housing Payment: $   Monthly Housing Payment:  $
     
If Less Than 2 Years Please Provide Past Address:   If Less Than 2 Years Please Provide Past Address:
Street: City:
 
Street: City:
State: Zip:
 
State: Zip:

 
Current Employer:
Business Phone:
 
Current Employer:
Business Phone:
Date Of Hire:   Date Of Hire:
Job Title:   Job Title:
Gross Salary: $       Gross Salary: $    
Frequency:   Frequency:
(You do not need to provide information about alimony, child support, separate maintenance or other sources of income if you do not wish to have them considered as income.)
Other Income: $   Other Income: $
Frequency:   Frequency:
Source Of Income:   Source Of Income:
     
REFERENCES
Nearest Relative (Not Spouse):   Personal:
 
Phone:   Phone:
Address:   Address:
     
Please Tell Us About Your Debts:
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
 
OTHER INFORMATION
Would you like to purchase Single Credit Disability Insurance?
Yes None
   
Have You Filed For Bankruptcy? Are You A U.S. Citizen Or Permanent Resident Alien?
Are You  A Co-Maker/Endorser On Any Loan?
If Yes, Then For Whom? Balance:
Do You Currently Have Any Outstanding Judgements Or Have You Had A Debt Adjustment, Repossession, Or Property Foreclosed In The Last 7 Years Or Are A Party To A Lawsuit?

You agree that everything stated in this application is correct to the best of your knowledge. The Credit Union is authorized to investigate your creditworthiness, employment history, and to obtain a credit report to answer questions about their credit experience with you. You understand that any false or misleading statement in your application may cause any loan or extension of credit to be in default. You authorize us to accept your facsimile signatures on this application and agree that your facsimile signature will have the same legal force and effect as your original signature. You assume any risk that may be associated with permitting us to accept your facsimile signature. Security on one loan is security on any monies owed to the Credit Union.

PLEASE MAIL, FAX, OR BRING INTO TO OUR OFFICE YOUR MOST RECENT PAY CHECK STUB.

By pressing the "Submit Application" button below, you agree to the above statement. You understand that we may require additional information to finalize our credit decision and your signature on additional documents prior to disbursing any credit proceeds.