An Equal Housing Lender 

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Please Enter your Email Address:

If you are applying for joint credit, secured credit or if you live in a community property state (AZ,CA,ID,LA,NM,NV,TX,WA,WI,Puerto Rico), please complete the following:
Married Separated Unmarried (Single, Divorced, Widowed)

Type of Loan Applied For:
Personal (Signature) Share Secured Home Equity New Car Used Car
Other:
For Visa Credit Cards, Unsecured Lines of Credit, and Home Equity Lines of Credit please contact the credit union for further information.

Amount applied for: $
Purpose:
Desired Length of Repayment (mon):

Method of Payment:
Coupons Payroll Deduction Automatic Transfer from Shares Drafts

Check Coverage(s) desired:
The credit union will disclose the cost of this voluntary insurance to you. A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.
Single Life Disability & Unemployment Debt Protection Joint Life Disability & Unemployment Debt Protection
Single Life Disability Debt Protection Joint Life Disability Debt Protection
Single Disability Debt Protection Joint Disability Debt Protection
Single Life Debt Protection  Joint Life Debt Protection
No Protection  

Applicant:

Name:
Account #:
Social Security #:
Birthdate (MM/DD/YY):
Home Phone #:
Present Address:
Street:
City:
State & Zip:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:

Joint Applicant:

Name:
Account #:
Social Security #:
Birthdate (MM/DD/YY):
Home Phone #:
Present Address:
Street:
City:
State & Zip:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:

Employment and Income: In order to expedite the processing of your loan application please fax your paystub copies to (724) 438-7491, Attention: Loan Department. If self-employed or retired, financial statement or income tax returns will be needed.
Employer Name:

Employer Phone #:
Employer Address:

Position:
Date Hired (MM/DD/YY):
Monthly Gross Income: $
Other Income: $ per Month
Source of Other Income/ Employer Name:

Date Hired (MM/DD/YY):
Employer Name:

Employer Phone #:
Employer Address:

Position:
Date Hired (MM/DD/YY):
Monthly Gross Income: $
Other Income: $ per Month
Source of Other Income/ Employer Name:

Date Hired (MM/DD/YY):

NOTE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for this credit request.
Complete if current is less than 2 years:
Previous Employers Name:

Years Employed:

Complete if current is less than 2 years:
Previous Employers Name:

Years Employed:
Credit Information
Please list all open Accounts with a balance.
Creditor Monthly
Payment
Housing
Rent Own None
Creditor Monthly
Payment
Housing
Rent Own None

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 and 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.

By pressing the "Send Application" 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.

For Office use only.

 

_____________________________________________
Applicant Signature                                                    Date

_____________________________________________
Joint Applicant Signature                                            Date