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Secure Loan Application


2209 West State Street, New Castle, PA 16101
Phone: (724)652-8393  •  Fax: (724)652-8855
Organization NMLS: 417690
Michael Vatter NMLS: 576825
Susan Kanary NMLS: 1214851



Type Of Loan Applying For

New or Used Vehicle Loan
Recreational Vehicle (Camper, ATV, Motorcyle, etc.)
Home Equity / Second Mortgage Loan
Share Secured Loan

Personal Loan
VISA Credit Card Visa Disclosure
I have read and agree with Terms and Conditions
Other:
Description of collateral :
Purpose of loan :
Requested Amount : $ .00
Requested Term:
Payment Method: Weekly Bi-Weekly Monthly Semi-Monthly

Payment Protection Coverage None
Check coverage(s) desired. The Credit Union will disclose the cost of this voluntary debt protection to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.
Debt Protection Single Loss of Life
Debt Protection Single Loss of Life and Disability
Debt Protection Single Loss of Life, Disability, and Involuntary Unemployment
None
Debt Protection Joint Loss of Life
Debt Protection Joint Loss of Life and Disability
Debt Protection Joint Loss of Life, Disability, and Involuntary Unemployment
Gap Coverage (Vehicle, Motorcycle, ATV, Snowmobile, RV, or Watercraft Loans Only)

Applicant Information
Applicant's Name:
Account #:
Social Security #:
US Citizen: Yes No
Birthdate (MM/DD/YY):
Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:
Marital Status:
Email Address :
Number of Dependents :
We consider the primary borrower one dependent, a spouse would be the second dependent and then children would be subsequent dependents.
Home Phone #:
Mobile Phone #:
Work Phone #:
Address :
City : State:
Zip #:
Current Address since: (MM/YY)
Rent     Own     Payment:
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Is Joint Applicant your spouse? Yes No
Account #:
Social Security #:
US Citizen: Yes No
Birthdate (MM/DD/YY):
Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:
Marital Status:
Email Address :
Number of Dependents :
We consider the primary borrower one dependent, a spouse would be the second dependent and then children would be subsequent dependents.
Home Phone #:
Work Phone #:
Mobile Phone #:
Address :
City : State:
Zip #:
Current Address since: (MM/YY)
Rent     Own     Payment:
If less than 3 yrs enter previous address:

Employment Information
Applicant Employer's Name:
Employer Phone #:
Employer Address:
Position:
Status: Full Time Part Time
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
Joint App. Employer's Name:
Employer Phone #:
Employer Address:
Position:
Status: Full Time Part Time
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
NOTE: Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Debts & Assets
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
Child Support Payments / Alimony $
Assets:
Description: Value:
    
Description: Value:
    
Have you ever filed for bankruptcy or had debt adjustment under Chapter 13?
   Are you a party in a lawsuit?
   Have you ever had property foreclosed or repossesion in the last 7 years?
   Is your income likely to decline in the next two years?
Are you co-maker/endorser on any loan not listed above?
   If yes then for whom?
   If yes then to whom?



Applicant References (Nearest relative not living with you)
Reference #1
First Name: Middle Name: Last Name: Suffix:
   Home Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?

Comments
  

Submit Application

Preferred branch location for closing loan?

I/We understand that credit union membership is required to fully process this loan application and further documentation / signatures may be required. By submitting this form with your electronic signature(s), you agree that everything stated in this application is correct to the best of your knowledge and grant permission to First Choice FCU to perform the following. First Choice FCU is authorized to validate your information, investigate your creditworthiness, employment history, and obtain a credit report. 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. First Choice FCU may keep this application whether or not it is approved.

By pressing the "Submit Application" button below, you agree to the above statement.  

To avoid delays in processing your request please provide us with the best method and time to contact.
Best method of contact:
Home Phone      Mobile Phone      Work Phone              What time of day is best to call:


Date:
Primary Signature:
Joint Signature: