Unauthorized Access Prohibited

RHSECU

Riverside Health System ECU Loan App


     Type of loan requested         
     Amount requested               
     Purpose                        

Combine with existing loan? Yes No
Payment Protection:
Life Insurance Yes No
Disability Insurance Yes No

Co-Applicant Disclosure:

You understand that as co-applicant you make yourself liable with other signers of the note. You are certifing that statements on this application are true and complete. You authorize any person, association, firm or corporation to furnish on request of this credit union, information concerning me or my financial affairs. You agree that loan funds may be disbursed directly to maker/applicant.  It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.


Applicant Disclosure:

You promise that everything you have stated in this application is correct to the best of your knowledge.  You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, renewal or extension of the credit received.  You understand that the credit union will rely on this information in this application and your credit report to make it decisions. If you would like and request, the credit union will tell you the names and addresses of any credit bureau from which it received the credit report.  It is a federal crime to willfully and deliberately provide incomplete or incorrect informaton on loans applications made to federal credit unions or state chartered credit unions insured by NCUA.


Applicant Information

Please complete all of the information on this application. If this is your first time borrowing, please fax your most recent pay-stub from any full or part-time employment that you wish to disclose for credit consideration. Fax number 757 594-3644. Account Number First Name Last Name Social Security # Birthdate Address City State Zipcode Please list previous address if living at current address less than 5 years. Previous Address City State Zipcode Phone
Employer Name & Department Employer Phone Number Job Start Date Month/Year Gross Income Hourly/Monthly/Annually Job Title Other Income (where and amount)
Email Address Drivers License Number State

Debts Monthly Payment Ever filed Bankruptcy? Yes No
Ever had judgements filed against you? Yes No
Are you a US citizen? Yes No

Co-Applicant Information

Please fax your most recent pay-stub from any full or part-time employment
that you wish to disclose for credit consideration. Fax number 757 594-3644.

Account Number Last Name/First Name Social Security # Birthdate Address City State Zipcode Phone
Employer Name Employer Phone Number Job Start Date Month/Year Gross Income Hourly/Monthly/Annually Job Title Email Address


NCUA AND EHL

Copyright 2003 RHS Employees Credit Union