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Wednesday, February 22, 2012
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PDF Logo PAC FCU Loan Application

Port Arthur Community Federal Credit Union Loan Application

Please print this form, fill it out and fax to (409-729-7948)

To fill out this form choose either to print out the form below, or use the PDF version to fill out and email it.


General Information:
Will you be applying for Individual or Joint Credit: Joint Individual
If applying for joint credit, please sign below to verify that you intend to apply for joint credit
Applicant: Co-Applicant:
Marital Status: Complete marital status if this loan is for:
a. Joint or secured credit, or
b. You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)
Unmarried
Married
Separated
This loan is not for joint or secured credit and I do not live in the states listed above.
Type of Loan Requested:
Loan Amount Requested: Loan Term Requested:
Primary Applicant:
Last Name: Member Number:
First Name: Middle Name:
Social Security Number (TIN): Date of Birth:
Number of Dependents: Ages of Dependents:
Home Phone Number: Work Phone Number:
Other Phone Number: Email Address:
Drivers License #: Drivers License State:
Home Address
Address 1:
Address 2:
City: State, Zip:
Time at Current Residence: Residence Type: Rent Own Other:
Monthly Payment:
Previous Address
Address 1:
Address 2:
City: State, Zip:
Time at Previous Residence: Residence Type: Rent Own Other:
Present Employer
Name: Phone Number:
Employment Status: Full Time Part Time Temp Retired Other (please specify):
Job Title: Job Start Date:
Gross Salary: per Year Month Hour
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Other Income: per Year Month Hour
Other Income Source:
Previous Employer
Name: Phone Number:
Employment Status: Full Time Part Time Temp Retired Other (please specify):
Job Title: Job Start Date:
Job End Date:
Gross Salary: per Year Month Hour
Co-Applicant:
Last Name: Member Number:
First Name: Middle Name:
Social Security Number (TIN): Date of Birth:
Number of Dependents: Ages of Dependents:
Home Phone Number: Work Phone Number:
Other Phone Number: Email Address:
Drivers License #: Drivers License State:
Home Address
Address 1:
Address 2:
City: State, Zip:
Time at Current Residence: Residence Type: Rent Own Other:
Monthly Payment:
Previous Address
Address 1:
Address 2:
City: State, Zip:
Time at Previous Residence: Residence Type: Rent Own Other:
Present Employer
Name: Phone Number:
Employment Status: Full Time Part Time Temp Retired Other (please specify):
Job Title: Job Start Date:
Gross Salary: per Year Month Hour
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Other Income: per Year Month Hour
Other Income Source:
Previous Employer
Name: Phone Number:
Employment Status: Full Time Part Time Temp Retired Other (please specify):
Job Title: Job Start Date:
Job End Date:
Gross Salary: per Year Month Hour
References
Nearest Relative Not Living With You
Last Name: First Name:
Relationship: Phone Number:
Address 1:
Address 2:
City: State, Zip:
Debts/Monthly Payments:
List all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support,
child care, medical, utilities, auto insurance, IRS liabilities, etc.) Please use a separate line for each credit card and auto loan.
Debt Monthly Payment Debt Monthly Payment
Additional Information
How would you prefer to be contacted?
Home Phone
Work Phone
Other Phone
Email Address
Other:
Special Instructions/Comments:
Signatures
Income verification is required; other information may be required.

I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Financial Institution, information concerning me or my affairs.(Sec. 1014, Title 18, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.)
Primary Signature: Date:
Joint Owner Signature: Date:
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Lobby Hours:
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Saturday
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 Drive Thru Hours:
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Friday
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Saturday
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Port Arthur Community Federal Credit Union
3100 Central Mall Drive
Port Arthur, TX 77642
Phone Numbers:
(409)729-7938
(409) 729-7948 FAX
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