EXMOUTH BRANCH
1205 Exmounth St.
Sarnia, ON
Ph 519-383-0750
CORUNNA BRANCH
411 Lyndoch St.
Corunna, ON
Ph 519-862-1421
WALLACEBURG BRANCH
57 McNaughton Ave.
Wallaceburg, ON
Ph 519-627-6744
WYOMING BRANCH
618 Broadway St.
Wyoming, ON
Ph 519-845-3362
Amount Being Applied For

Name and Address

(yyyy-mm-dd)

Previous Address

If At Current Address For Less Than Three (3) Years

Housing Information

Employer

Previous Employer

If At Current Employer For Less Than Three (3) Years

Income

Co-Applicant Information
Name and Address

If At Current Address For Less Than Three (3) Years

Housing Information

Employer

Previous Employer

If At Current Employer For Less Than Three (3) Years

Income

Liabilities
Name of Creditor Payment Balance Credit Limit
Assets
Asset Value
Acceptance of Terms and Disclosure

By submitting this form you consent to the obtaining of such personal or credit information as Southwest Regional Credit Union may require at any time in connection with the credit hereby applied for, or any renewal or extension thereof: and further consents to the disclosure of any information concerning the undersigned to any credit reporting agency, or any person with whom the undersigned, has or proposes to have financial dealings.

I am not indepted to any other Credit Union, bank, loan agency or individual either as maker or endorser except as stated above. The statements herein are made for the purpose of obtaining this loan and are true to the best of my knowledge and belief.

I/we understand additional information may be required from me/us to complete the credit request such as confirmation of income and I/we will be required to open a membership with Southwest Regional Credit Union that will require supporting documentation such as photo identification.

Yes

Yes

Yes