Loan Application

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Home
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- About Us
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Resources
Services
Rates
Contact Us

Loan Information App Type App Type Folder

Primary Information

Will this be a Single or Joint Application?*

Single Application

Joint Application

First Name*

Last Name*

Account Number*

Email*

Home Phone*

No dashes, spaces, or parentheses

Cell Phone*

No dashes, spaces, or parentheses

Type of Loan*

VIN #

Make

Model

Year

Mileage

Loan Purpose*

Loan Term (in months)*

Amount Requested*

Enter a value no greater than 999,999

Repayment Method

Payroll Deduction

Cash

Military Allotment

Automatic Payment

Would you like Debt Protection with this loan?

Life Plus

Life Plus and Disability

Life Plus, Disability and Involuntary Unemployment

No Protection

Personal Information

Primary Applicant - Personal information

Social Security No.*

No dashes, spaces, or parentheses

Driver's License No.*

No dashes, spaces, or parentheses

Driver's License State*

Date of Birth*

Address*

Address 2

City*

State*

Zip Code*

Years There*

Previous Address (if less than 2 years at present address)

Address 2

City

State

Zip Code

Years There

Previous Address (if less than 2 years at present address)

Address 2

City

State

Zip Code

Years There

No. of Dependents*

Complete for joint credit, secured credit, or if you live in a community property state*

I am Single

I am Married

I am Separated

Employment information

Do work full time or part time?*

Full Time

Part Time

Current Employer*

Position*

Annual Income*

Employee Start Date*

Previous employer (if less than 2 years at present employer)

Start date

Other Income

Source

Credit information

Residence

I own my residence

I rent my residence

I live with relatives

Present Mortgage Co., Landlord, or Relative

Monthly Mortgage/Rent Payment (includes taxes and insurance)

Current Value. If you own your home, what is the current value?

Mortgage Balance

Is the property described your principal dwelling?

Yes, the property is my principal dwelling

No, the property is not my principal dwelling

Any proceeds for a Refinanced Mortgage, Home Equity, or Home Improvement?

Yes, there are proceeds

No, there are not proceeds

Is the property described listed as the applicant's address in the "Personal Information" section?

Yes, the addresses are the same

No, the addresses are different

Other liens

Is anyone other than your spouse a part owner of your home?

Yes, there is another owner of my home

No, there is not another owner of my home

Have you ever had a car or other personal property repossessed by a dealer or finance company, filed for bankruptcy, or been a party to a wage assignment or collection suit, or have you ever been declined on a loan application with this credit union?

Yes

Reference

Name of nearest relative not living with you*

Relatives Address*

Address 2

City*

State*

Zip Code*

Relationship*

Phone*

No dashes, spaces, or parentheses

Additional Questions

Are you other than a US citizen or permanent resident alien?*

Yes, I am other than a US Citizen or permanent resident alien

No, I am not other than a US Citizen or permanent resident alien

Do you have any outstanding judgments?*

Yes, I have outstanding judgments

No, I do not have outstanding judgments

Is your income likely to decline in the next two years?*

Yes, my income is likely to decline

No, my income is not likely to decline

Are you a co-maker, co-signer, or guarantor on any loan not listed?*

Yes, I am a co-maker

No, I am not a co-maker

Have you filed for bankruptcy or had a debt adjustment plan confirmed under chapter 13?*

Yes, I have filed for bankruptcy or debt adjustment

No, I have not filed for bankruptcy or debt adjustment

Have you had property foreclosed upon or given a deed in lieu of foreclosure in the last 7 years?*

Yes, I have had property foreclosed

No, I have not had property foreclosed

Are you a party to a lawsuit?*

Yes, I am party to a lawsuit

No, I am not party to a lawsuit

Joint Information

Joint Applicant - Personal information

First Name*

Last Name*

Email*

Phone (Best contact phone #)*

No dashes, spaces, or parentheses

Cell Phone*

No dashes, spaces, or parentheses

Social Security No.*

No dashes, spaces, or parentheses

Driver's License No.*

No dashes, spaces, or parentheses

Driver's License State*

Date of Birth*

Address*

Address 2

City*

State*

Zip Code*

Years There*

Previous Address (if less than 2 years at present address)

Address 2

City

State

Zip Code

Years There

No. of Dependents*

Complete for joint credit, secured credit, or if you live in a community property state*

I am Single

I am Married

I am Separated

Employment information

Do work full time or part time?*

Full Time

Part Time

Current Employer*

Position*

Annual Income*

Employee Start Date*

Previous employer (if less than 2 years at present employer)

Credit information

Residence

I own my residence

I rent my residence

I live with relatives

Present Mortgage Co., Landlord, or Relative

Monthly Mortgage/Rent Payment (includes taxes and insurance)

Current Value. If you own your home, what is the current value?

Mortgage Balance

Is the property described your principal dwelling?

Yes, the property is my principal dwelling

No, the property is not my principal dwelling

Any proceeds for a Refinanced Mortgage, Home Equity, or Home Improvement?

Yes, there are proceeds

No, there are not proceeds

Is the property described listed as the applicant's address in the "Personal Information" section?

Yes, the addresses are the same

No, the addresses are different

Other liens

Is anyone other than your spouse a part owner of your home?

Yes, there is another owner of my home

No, there is not another owner of my home

Yes

Reference

Name of nearest relative not living with you*

Relatives Address*

Address 2

City*

State*

Zip Code*

Relationship*

Phone*

No dashes, spaces, or parentheses

Additional Questions

Are you a US citizen or permanent resident alien?

Yes, I am a US Citizen or permanent resident alien

No, I am not a US Citizen or permanent resident alien

Do you have any outstanding judgments?

Yes, I have outstanding judgments

No, I do not have outstanding judgments

Is your income likely to decline in the next two years?

Yes, my income is likely to decline

No, my income is not likely to decline

Are you a co-maker, co-signer, or guarantor on any loan not listed?

Yes, I am a co-maker

No, I am not a co-maker

Have you filed for bankruptcy or had a debt adjustment plan confirmed under chapter 13?

Yes, I have filed for bankruptcy or debt adjustment

No, I have not filed for bankruptcy or debt adjustment

Have you had property foreclosed upon or given a deed in lieu of foreclosure in the last 7 years?

Yes, I have had property foreclosed

No, I have not had property foreclosed

Are you a party to a lawsuit?*

Yes, I am party to a lawsuit

No, I am not party to a lawsuit

Agree and Submit

Disclosure and Agreement to Terms

Terms & Conditions

Read the important information below before submitting your request. Depending on the nature of this request, these disclosures may contain important information regarding applicable rates, fees and other costs.

Credit Report Authorization: By submitting this request, you authorize the Credit Union to obtain credit reports in connection with this request for credit and for any update, increase, renewal, extension, or collection of the credit received and for other accounts, products, or services we may offer you or for which you may qualify. You understand that the Credit Union will rely on information in this request and your credit report to make its decision. When applicable, spousal information may be requested as a part of this request. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. Accuracy of Information: It is a crime to willfully and deliberately provide incomplete or incorrect information in this request. Note: A confirmation email will be sent to the email address provided confirming we received your loan request.By clicking "Submit", all parties agree the checking of the box(es) above and submitting this request constitutes an electronic signature which is the legal equivalent of a written signature and is a binding and enforceable signature.

Do you agree with the above terms and conditions?*

Yes, I agree to the terms

No, I do not agree to the terms

Signature (type your full name)*

Date*

Upload the most recent copy of your paystub

Upload the second most recent copy of your paystub

Co-Applicant

Do you agree with the above terms and conditions?*

Yes, I agree to the terms

No, I do not agree to the terms

Signature (type your full name)*

Date*

Upload the most recent copy of your paystub

Upload the second most recent copy of your paystub

Oops! We have invalid fields. Double check the form before we can submit.

608 Rostraver Road Belle
Vernon, PA 15012

Phone: (724) 930-9864
Fax: (724) 930-9865

Email the Credit Union

To Report Lost/Stolen Debit Cards after hours call: 1-888-263-3370
Credit Cards After Hours Call: 1-800-991-4961

Day	Hours of Operation
Monday	9:00 AM – 4:30 PM
Tuesday	9:00 AM – 4:30 PM
Wednesday	9:00 AM – 4:30 PM
Thursday	9:00 AM – 4:30 PM
Friday	9:00 AM – 4:30 PM

Your savings are federally insured up to $250,000 NCUA (National Credit Union Administration) a US government agency. Equal Housing Lender. The Credit Union is committed to providing a website that is accessible to the widest possible audience in accordance with ADA standards and guidelines. We are actively working to increase accessibility and usability of our website to everyone. If you are using a screen reader or other auxiliary aid and are having problems using this website, please contact us at (724) 930-9864 . All products and services available on this website are available at our credit union office.

Third Party Links Disclosure

Our site contains hyperlinks to other web sites operated by third parties. These links will take you away from our site. Please note that we do not guarantee the accuracy or completeness of any information presented on these sites nor do we represent either the third party or our member if the two enter into a transaction. The third party's privacy and security policies may differ from those practiced by the credit union. We encourage our members to know when they leave our site and to read the privacy statements of each and every web site that collects personally identifiable information. Our Privacy Statement applies solely to information collected by our web site.