Loan Application

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LOAN APPLICATION/VERIFICATION

Amount Requested* $

Purpose of Loan*

Are you applying for credit individually or jointly with someone else?*

Individual Joint

You must complete the Applicant section about yourself and the other section about your spouse if you are relying on your spouse's income as a basis for repayment. For Joint credit, each applicant must individually complete the appropriate section below.

I am interested in adding Debt Protection to my loan.

Yes

Payment Protection protects you and your family from unforeseen circumstances, including loss of a life, an unexpected disability, loss of employment, or an emergency that requires you to take a leave of absence to care for a family member. All of these "protected events" are difficult to manage. With each new debt added to your plate, it becomes more important to have some type of protection. Payment Protection does just that. Whether paying off a loan due to a death, or making monthly loan payments, you will protect yourself and your family.

Please add Guaranteed Asset Protection (GAP) Guaranteed Asset Protection (GAP) to my loan.(Auto Loan Only)

Yes

If your car is totaled/stolen for any reason, the amount of reimbursement you receive from your insurance company may be substantially less than the amount you owe on your car loan. Unless you’re covered by gap insurance, this financial shortfall, or “GAP” could leave you owing thousands of dollars. Ask one of our Loan Reps for more information.

Please add Mechanical Breakdown Protection (MBP) to my loan. (Auto Loan Only)

Yes

For just pennies a day, MBP shields you from the high costs of mechanical or electrical repairs on your vehicle once your basic manufacturer’s warranty has expired. In addition, MBP also provides comprehensive roadside assistance, nationwide coverage, and the flexibility to choose a repair facility of your choice. Before you commit to any other program, compare it to our major mechanical protection plans.

Personal Information

Name*

First Name

Last Name

Email Address*

Current Address (No P.O. Box)*

Address Line 1

Address Line 2

City

State

ZIP Code

Do you own or rent?*

Own Rent

Monthly Rent/Mortgage payment* $

Preferred Phone Number*

Social Security Number*

Date of Birth*

Marital Status*

Single Married Unmarried (including widowed or divorced)

Employment Information

Current Employer*

Employer Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Job Title*

Date of Hire*

Upload

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Please upload two most recent paystubs

Upload

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Please upload two most recent paystubs

Gross Income* $

Frequency*

Select One

Reference

Name*

First Name

Last Name

Relationship to Applicant*

Phone Number*

Other Information

Are you a U.S. Citizen or Permanent Resident Alien?*

Yes No

Have you ever filed for bankruptcy ?

Yes No

Are you a current member of Port Arthur Community FCU?

Yes No

By submitting this application you affirm the following:

The information you have stated in this application is correct to the best of your knowledge and you are authorized to submit the application;
You authorize the credit union to obtain a copy of your credit report and verify your employment;
The credit union will rely on the information in this application and your credit report to make its decision;
It is a crime to willfully and deliberately provide incomplete or incorrect information on this application

Signature*

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