Applicant Information
Co-Applicant Information
Name
and Address Information
Account Number*
Account Number
Full Name*
Full Name
Driver's License
Social Security Number*
Date of Birth
Driver's License
Social Security Number
Date of Birth
Home Phone*
Home Phone
Address*
Address
City*
City
State/Province*
State/Province
Zip Code/Postal Code*
Zip Code/Postal Code
Own Rent
Credit Card
Monthly Mortgage or Rent Payment*
Car Financing
Total of All Other Monthly
Payments*
Total of All Monthly Payments
Current Employer Name*
Current Employer Name
Current Employer Address*
Current Employer Address
Current Employer City*
Current Employer City
Current Employer State*
Current Employer State
Current Employer Zip Code*
Current Employer Zip Code
Work Phone*
Work Phone
Work Start Date*
Work Start Date
Position*
Position
Salary Information
You MUST enter your salary information for
this application to be processed. Salary information is not noted as
"required" (marked with an asterisk) because there are too many variables in the
way you can report your salary.
Number of Hours You Work Per
Week*
Number of Hours You Work Per Week
Current Hourly Salary Rate, If
Hourly
Current Hourly Salary Rate, If
Hourly
Base Salary per Month Year
Gross
Net
Base Salary per Month
Year
Gross Net
Other Income per Month Year
Gross
Net
Other Income per Month
Year
Gross Net
Source of Other Income
Source of Other Income
Requested Loan Amount*
Do you want Disability Insurance?
Purpose of Loan*
Do you want Credit Life Insurance?
Number of Months to Repay
Do you want to have both, Disability and
Credit Life Insurance?
Best Daytime Phone Number*
Additional Comments
Once you have completed all the required fields, please print this
form, date and sign here and fax to LA Electrical Workers Credit
Union at
(626) 440-9485. Should you have any questions
regarding this form or it's contents, please call the Credit Union
at (626) 440-9 284.
Date
Applicant Signature
Co-Applicant Signature
Thank you for using our website application.
In addition to
basic information, you will need to provide employment and income information, the amount
of your monthly mortgage or rent payment, and the total amount of all your monthly
payments. Please answer each question as accurately as possible. Providing accurate
information will expedite your loan request.
By placing this web request, you certify that all statements made are true and complete.
You authorize the credit union to obtain any information necessary to process this
request, including a credit report. An L.A. Electrical
Workers Credit Union representative will
contact you when your loan request is approved or if any additional information is needed.