FAYETTE COUNTY SCHOOL EMPLOYEES CREDIT UNION
Secure Loan Application
193 Edison St., Uniontown, PA 15401 • Phone: (724) 438-9019 • Fax: (724) 438-7955
Account Number Amount Requested Type Of Loan Applying For Term
$ Months
Reason For Loan?
PRIMARY APPLICANT
  
JOINT APPLICANT

Name: First, Middle, Last

 Name: First, Middle, Last
Social Security Number:
 Date of Birth:
Drivers License #:
 DL State:
 
Social Security Number:
 Date of Birth:
Drivers License #:
 DL State:
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:
How long at residence?   How long at residence?
Monthly Housing Payment: $   Monthly Housing Payment:  $
Current Employer:
 Business Phone:
 
Current Employer:
 Business Phone:
Job Title:       Job Title:    
9 Month Employee?       9 Month Employee?    
Length of Employement:       Length of Employement:    
Start Date of Employement:       Start Date of Employement:    
Address of Employer:
   		   Address of Employer:
    
Supervisor's Name:
   		   Supervisor's Name:
    
Gross Salary: $       Gross Salary: $    
Frequency:   Frequency:
Other Income: $   Other Income: $
Frequency:   Frequency:
Source Of Income:   Source Of Income:
     
Personal Reference:   Personal Reference:
Name of Reference:
    		   Name of Reference:
    
Street:
 City:
   Street:
 City:
State:
 Zip:
   State:
 Zip:
Phone Number:   Phone Number:
 
OTHER INFORMATION
(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.)
 
Are you interested in having your loan protected??
 Yes No
If you answer “yes”, the credit union will disclose the cost to protect your loan. The credit insurance is voluntary and does not affect your loan approval. In order for your loan to be covered, you will need to sign a separate application that explains the terms and conditions.
   
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 forceand 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.