PFCU LOAN APPLICATION INFORMATION
MEMBER NAME_______________________________ ACCOUNT#_____________
LOAN TYPE_________________
Effective 5/16/07 only two 90 day notes allowed within 365 day period 1st___ 2nd ___
LOAN PURPOSE_______________________ AMOUNT REQUESTED___________
Credit report run by PFCU within the last 90 days? _______
$15.00 fee paid by: Cash: _________ Savings: ________ Checking: ________
INSURANCE ON LOAN? Disability: ____________ Life: ____________
INCOME AMOUNT: Annually: _________ Weekly: ________ Hourly_______
LOAN PAYMENT: Weekly:___ Bi weekly: ___ Semi-monthly: ___ Monthly: ___
TERM OF LOAN: 90 Days: ___ 10 Months: ___ Years: ________ Interest % _____
PAYROLL DEDUCTION: Yes: ____ No: ____ OTC COUPONS: Yes____
MORTAGE PAYMENT: __________ MONTHLY RENTAL: ____________
VALUE OF HOME OR VEHICLE: _______________________________
NUMBER OF DEPENDENTS: _________________
NEAREST RELATIVE NOT LIVING WITH YOU
NAME_________________ RELATIONSHIP______________
PHONE #______________
MEMBER FOR AT LEAST 90 DAYS____________________
ARE YOU CURRENTLY EMPLOYED__________________
CURRENT EMPLOYER FOR AT LEAST 1 YEAR_________
HAVE YOU RECENTLY OR ARE YOU LIKELY TO FILE
FOR BANKRUPTCY IN THE NEXT 90 DAYS______________
______________________________ __________________
SIGNATURE DATE