WBRT Federal Credit Union Loan Application

Loan Requirements:

• You must provide proof of income with loan application

• You must have a share savings balance of at least $155.00

• You must submit a $20.00 non-refundable loan application fee

Other criteria may be required for certain loan types. Please contact the credit union for more information.

Page 1 of 5 - Member's Information

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Name Name First Middle Last
Address (Other than P.O. Box) Address (Other than P.O. Box)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Mailing Address (If Different from Physical Address) Mailing Address (If Different from Physical Address)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Number Home Phone Number - ### - ### ####

If you do not have a home phone number, please list your cell phone number.
Cell Phone Number Cell Phone Number - ### - ### ####

If you do not have a cell phone number, please list your home phone number.
Work Phone Number Work Phone Number - ### - ### ####

If you do not have a cell phone number, please list your home phone number.
Work Phone Number Extension
Birthdate Birthdate / MM / DD YYYY
Driver's License Number
Driver's License State
Number of Dependents (Excluding self)
I Hereby Apply for a Loan of: $ Dollars . Cents
Type of Loan (Other Requirements For These Loans, Contact Office For More Information)

Type of Loan (Other Requirements For These Loans, Contact Office For More Information) Refinanced Signature Loan New Signature Loan Auto Loan Shared Secured Loan Short Term Loan ($200 for 2 month period) Holiday/Summer Loan (during promotional period only)
Duration of Loan

Duration of Loan 6 months 12 months 18 months 24 months 36 months 48 months 60 months 72 months
Monthly Payment Date

For example: the 15th of each month
Purpose of Loan

Do not just write "Personal." Please be specific
Collateral Offered
Are you interested in having credit disability insurance?

Are you interested in having credit disability insurance? Yes No
If yes, are you actively at work for 25 hours or more per week on the date you sign this application?

If yes, are you actively at work for 25 hours or more per week on the date you sign this application? Yes No
Are you interested in having credit life insurance?

Are you interested in having credit life insurance? Yes No

WBRT Federal Credit Union Loan Application

WBRT Federal Credit Union Loan Application

Page 1 of 5 - Member's Information