1000 Bower Hill Road, Pittsburgh, PA  15243
Phone: (412) 942-1261  •  Fax: (412) 942-1279
Secure Loan Application
1. Member Number

You must be a South Hills Healthcare Federal Credit Union member to apply for a loan.
 
2 .Type Of Loan Applying For

New Auto Loan
Used Auto Loan
Motorcycle

Personal Loan: (purpose)
Savings Secured
VISA Credit Card - Classic  (VISA Disclosure»)
 
3. Payment Protection Plan
3.1 Would you like to purchase Credit Life Insurance? ( See credit union for cost information))
Single Credit Life
Joint Credit Life
Borrower #1   Borrower #2
None

3.2 Would you like to purchase Credit Disability Insurance? (See credit union for cost information)
Single Credit Disability - Borrower #1
None
 
4. Loan Terms
4.1 - Are you submitting individually or jointly?
4.2 - Desired loan amount: $
4.3 - Repayment term:
4.4 - Desired Payment schedule:
4.5 - If required will you provide collateral to secure this loan?
   4.5a - If yes please describe collateral:
(ie., yr, make, model)
   4.5b - What is the value of the collateral? $ .00
4.6 - Method of Payment:
 
5. Primary Applicant
5.1 - Name:
First: Middle: Last: Suffix:
5.2 - Social Security Number:

555-55-5555
  5.3 - Date of birth:

mm/dd/yy
5.4 - What is your e-mail address?
(Re-enter your e-mail address)
5.5 - Home Phone Number:
555-555-5555
5.6 - What is your home address?
Street: City: State: Zip:
5.7 - Rent/Own/Buying:
   5.7a - Payment Amount:
5.8 - Time at residence:
5.9 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
5.10 - Mother's Maiden Name:
If Applying For An Individual Loan Click Here

6. Joint Applicant
6.1 - Joint Applicant Type:   
6.2 - Name:
First: Middle: Last: Suffix:
6.3 - Social Security Number:

555-55-5555
6.4 - Date of birth:

mm/dd/yy
6.5 - What is your e-mail address?
(Re-enter your e-mail address)
6.6 - Home Phone Number:
555-555-5555
6.7 - What is your home address?
Street: City: State: Zip:
6.8 - Rent/Own/Buying:
   6.8a - Payment Amount:
6.9 - Time at residence:
6.10 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
 
7. Employment Information - Applicant
7.1 - Current employer:
7.2 - Title or position:
7.3 - Are you self employed?
  7.3a - Type of Business
7.4 - Business phone number:
ext.
555-555-5555
7.5 - Date Started Position:
mm/dd/yy
(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.)
7.6 - Salary: $ .00
7.7 - Other income: $ .00
  7.7a - Source of income:
If Applying For An Individual Loan Click Here

8. Employment Information - Joint Applicant
8.1 - Current employer:
8.2 - Title or position:
8.3 - Are you self employed?
  8.3a - Type of Business:
8.4 - Business phone number:
ext.
555-555-5555
8.5 - Date Started Position:
mm/dd/yy
(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.)
8.6 - Salary: $ .00
8.7 - Other income: $ .00
  8.7a - Source of income:
 
9. Debts & Assets
9.1 - Please tell us about your assets:
  9.1a - Cash or equivalent: $ .00
  9.1b - Market Value of Home you Own: $ .00
  9.1c - Other assets (excluding real-estate): $ .00
9.2 Please tell us about your debts:
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
9.3 - Have you filed for bankruptcy?
  9.3a - Has this bankruptcy been discharged over four years ago?
  9.3b - (If less than four years) What year was the bankruptcy discharged?
9.4 - Are you co-maker/endorser on any loan not listed above?
  9.4a - If yes then for whom?
  9.4b - If yes then to whom?
9.5 - Are you a U.S. citizen or permanent resident alien?
   
10. References
10.1 - Nearest Relative NOT Living with you:
  10.1a - Name:
First: Middle: Last: Suffix:
  10.1b - Home Phone Number:
555-555-5555
  10.1c - What is their home address?
Street: City: State: Zip:
  10.1d - What is the relationship?

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 "Submit 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.
   

Submit Application