Southwest Regional Credit Union Loan Application

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

Amount Applying For:

Reason for the Loan:

Name and Address

Last name:

First name:

Middle name:

S.I.N.

Date of Birth: (yyyy-mm-dd)

Number & Street:

Apt #:

City:

Province:

Postal Code:

Length (years):

Length (months):

Home Phone #:

Cell Phone #:

Email Address:

Previous Address

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

Number & Street:

Apt #:

City:

Province:

Postal Code:

Length (years):

Length (months):

Housing Information

Own
Rent

Name & Address of Mortgage Holder or Landlord:

Rent/Mortgage Monthly Payment:

Property Taxes:

Mortgage Balance:

Value of Home:

Employer

Current Employer Name & Address:

Employer Phone #:

Occupation:

Length (years):

Length (months):

Previous Employer

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

Previous Employer Name & Address:

Occupation:

Number of Years:

Income

Gross Monthly Income:

Other Income:

Other Income Source:

Total Income:

Co-Applicant Information

Name and Address

Last name:

First name:

Middle name:

S.I.N.

Date of Birth:

Number & Street:

Apt #:

City:

Province:

Postal Code:

Length (years):

Length (months):

Home Phone #:

Cell Phone #:

Email Address:

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

Number & Street:

Apt #:

City:

Province:

Postal Code:

Length (years):

Length (months):

Housing Information

Own
Rent

Name & Address of Mortgage Holder or Landlord:

Rent/Mortgage Monthly Payment:

Property Taxes:

Mortgage Balance:

Value of Home:

Employer

Current Employer Name & Address:

Employer Phone #:

Occupation:

Employment length (years):

Employment length (months):

Previous Employer

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

Previous Employer Name & Address:

Occupation:

Income

Co gross monthly:

Co other monthly:

Other Income Source:

Co total 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.

**Have you ever declared Bankruptcy or part of a Consumer Proposal? Yes

If Yes, date of Discharge:

**Have you ever applied for credit at Southwest Regional Credit Union Ltd. Yes

**I/we agree to allow Southwest Regional Credit Union Ltd. to run a credit check. Yes