Secure Loan Application

Loan Type

Loan Purpose

Requested Amount ($)

Do You Want Credit Life?

Do You Want Credit Disability?

Method of Payment?

Payment Frequency?

Applicant Information

First Name

Last Name

Member #

Social Security #

Date of Birth

Email Address

Phone Number

Driver's License

Street Address

City

State

Zip Code

Years at This Address

Housing Status

Monthly Mortgage or Rent Payment

Previous Address

Years at This Address

Employment Information

Present Employer

Occupation

Employer Phone #

Years There

Gross Monthly Income for the Employer Above

Previous Employer

Occupation

Employer Phone #

Years There

References

Please provide two references that don't live with you.

First and Last Name

Relationship To You

Phone #

First and Last Name

Relationship To You

Phone #

Is there a joint applicant?

No Yes

Joint Applicant Information

First Name

Last Name

Member #

Social Security #

Date of Birth

Email Address

Phone Number

Driver's License

Street Address

City

State

Zip Code

Years at This Address

Housing Status

Monthly Housing Expense

Previous Address

Years at This Address

Joint – Employment Information

Present Employer

Occupation

Employer Phone #

Years There

Gross Monthly Income for the Employer Above

Previous Employer

Occupation

Employer Phone #

Years There

Joint – Personal References

Please provide two references that don't live with you.

First and Last Name

Relationship To You

Phone #

First and Last Name

Relationship To You

Phone #

Comments

Enter Comments Here

You promise that everything you have stated in this application is correct to the best of your knowledge and the above information is a complete listing of what you owe. If there are any important changes you will notify us in writing immediately. You authorize PBSFCU 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 PBSFCU will rely on the information in this application and your credit report to make its decision. If you request, PBSFCU 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 provide incomplete or incorrect information on loan applications made to federal credit unions or state-chartered credit unions insured by NCUA.

PLEASE MAIL, FAX, OR BRING INTO TO OUR OFFICE YOUR LAST THREE (3) RECENT PAYROLL STUBS OR STATEMENT, PROOF OF ADDRESS AND CURRENT PHOTO IDENTIFICATION. ONLINE PBSFCU BANKING USERS MAY ALSO UPLOAD THESE DOCUMENTS THROUGH SECURE MESSAGES.

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.

I have read this section and agree to the terms.

Loan Application

Applicant Information

Employment Information

References

Please provide two references that don't live with you.

Joint Applicant Information

Joint – Employment Information

Joint – Personal References

Please provide two references that don't live with you.

Comments

The Florist FCU Application and Solicitation Disclosure for VISA Platinum and VISA Secured

The Florist FCU
Application and Solicitation Disclosure
for VISA Platinum and VISA Secured