Secure Loan Request
7200 Kirkville Road, East Syracuse, NY 13057
Phone: (315) 656-8220  •  Fax: (315) 656-9389

Account Number -
If You Are A Member
Amount Requested Type Of Loan Request Term
Months
Have you requested funds in the past?
$

PRIMARY APPLICANT
 
JOINT APPLICANT

Name: First, Middle, Last

Name: First, Middle, Last
Social Security Number:
Date of Birth:
Drivers License Number:
 
Social Security Number:
Date of Birth:
Drivers License Number:
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:  $
   
(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.)
   
Current Employer:
Business Phone:
 
   
(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.)
   
Current Employer:
Business Phone:
Length Of Employment:   Length Of Employment:
Gross Salary: $       Gross Salary: $    
Frequency:   Frequency:
Other Income: $   Other Income: $
Frequency:   Frequency:
Source Of Income:   Source Of Income:
 
OTHER INFORMATION
 
Would you like to purchase Credit Life Insurance?
Individual Credit Life   Joint Credit Life None        Definitions
Would you like to purchase Individual Credit Disability Insurance? (Only available for applicant)
Yes None        Definitions
Would you like a quote on GAP Insurance?
Yes None        Definitions
The credit union will disclose the cost of this voluntary insurance to you. A separate election which discloses the terms and conditions must be signed for coverage to become effective.
   
Have You Ever 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?

Comments/Loan Purpose


" CORE Federal Credit Union WILL REQUEST INFORMATION TO VERIFY YOUR IDENTITY WHEN REQUIRED IN ACCORDANCE WITH THE USA PATRIOT ACT OF 2001."

You agree that everything stated in this request 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 and to answer questions about their credit experience with you. You understand that any false or misleading statement in your request may cause any loan or extension of credit to be in default. You also agree to pay;if applicable fees charged for credit reports, appraisal, and a title search even if the loan is not approved.

You authorize us to accept your facsimile signatures on this request 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. By initiating this request, you authorizing the credit union to obtain the necessary information, such as a credit report, to assist with the loan review process.

By pressing the "Send Request" button below, you agree to the above statement. You understand that we may require your signature on additional documents prior to disbursing any credit proceeds.

Information entered on this loan request form is sent to the credit union via a secure, encrypted transmission to safeguard your personal information.