Unauthorized Access Prohibited

RHSECU

Riverside Health System ECU Loan App


     Type Of Loan Requested         
     Amount Requested               
     Purpose                        
Home Phone Number

Combine with existing loan? Yes No



Co-Applicant Disclosure:

You understand that as co-applicant you make yourself liable with other signers of the note. You are certifying 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 yourself or your  financial affairs. It is a federal crime to willfully and deliberately provide incomplete or incorrect infromation on loan applications made to federal credit unions or state chartered credit unions insured by NCUA. You agree that loan funds may be disbursed directly to maker/applicant.


Applicant Disclosure:

You promise that everything you have stated in this application is correct to the best of your knowledge.  You are authorizing the credit union to obtain credit reports in connection with this application for credit and for any update, renewal or extension of credit received.  You understand that the credit union will rely on information in this application and your credit report to make its decision on whether to extend credit.  If you ask, the credit union will tell you the name and address of any credit bureau from which it received a credit report on you. 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 Information

Please complete all of the information on this application. Account Number Last Name First Name Social Security # Birthdate Email Address Employer Name & Department
Debts Monthly Payment
Ever filed Bankruptcy? Yes No
Ever had judgements filed against you? Yes No



Please notify us of any changes to the following items: Address City State Zipcode Employer Name Employer Phone Number Gross Income Hourly/Monthly/Annually Job Title

NCUA AND EHL

Copyright 2003 RHS Employees Credit Union