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ONLINE LOAN APPLICATION

Loan Calculator

In order to comply with the USA Patriot Act, effective October 25, 2002, PortAlliance is required to verify the identity of members applying for and opening new accounts or services with the credit union. Information that we are required to obtain include name, mailing and residential addresses, tax identification number, date of birth and a copy of government issued photo ID. Additional data may be gathered depending on the type of account opened. Data on existing members will be gathered as they open or use additional services offered by the credit union. The act requires us to maintain records of identity verification and periodically update this information.

How to Apply

  • Please complete application completely
  • Press the submit button at the end of the application
  • An incomplete application may delay processing
Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse, if:
  1. 1. you live in or the property pledged as collateral is located in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI).
  2. 2. your spouse will use the account, or
  3. 3. you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about the person on whose payments you are relying.
Joint Credit: If you are applying with another person, complete the Applicant and Other sections.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.
Check below to indicate the type of account(s) and type of credit for which you are applying. Married applicants may apply for a separate account.
 Account/Loan: Individual Joint
Amount Requested $ Purpose/Collateral:
(Including ATM/Debit Card Access to the Account if Available)

Repayment: Payroll Deduction Cash Military Allotment Automatic Payment
Payment
Protection		 Single Credit Disability Insurance
Single Credit Life Insurance
Joint Credit Life Insurance 		Check coverage(s) desired. The credit union will disclose the cost of this voluntary insurance to you. A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.
Applicant: Other: Co-Applicant Spouse Guarantor
Name (Last/First/Initial) Name (Last/First/Initial)
Account Number Social Security Number Account Number Social Security Number
Driver's License Number/State
 List ages of dependents not listed by other applicant (Exclude Self) Driver's License Number/State
 List ages of dependents not listed by other applicant (Exclude Self)
Birth Date
 Home Phone Business Phone/Ext. Birth Date
 Home Phone Business Phone/Ext.
Present Address (Street / City / Zip) Own Rent Present Address (Street / City / Zip) Own Rent
Years at
this Address 		Years at
this Address
Previous Address (Street / City / Zip) Own Rent Previous Address (Street / City / Zip) Own Rent
Years at
this Address 		Years at
this Address
Email address: Email address:
Complete for Joint Credit, Secured Credit Or if you live in a community property State:
Married Separated Unmarried
                                     (Single - Divorced - Widowed) 		Complete for Joint Credit, Secured Credit Or if you live in a community property State:
Married Separated Unmarried
                                     (Single - Divorced - Widowed)
Employment / Income
Name and Address of Employer
Employment / Income
Name and Address of Employer
Title/Grade
 Start Date Hours at work Title/Grade
 Start Date Hours at work
Supervisor's Name If self employed, type of business Supervisor's Name If self employed, type of business
Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered. Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income

$ per $ per Net Gross                  Source 		Employment Income

$ per $ per Net Gross                  Source
Military: Is duty station transfer expected during next year?
Yes No
Where                              Ending/Separation Date                 		Military: Is duty station transfer expected during next year?
Yes No
Where                              Ending/Separation Date                
Previous employer name and address if employed less Than five years
Starting Date
Ending Date
Previous employer name and address if employed less Than five years
Starting Date
Ending Date
Applicant Reference

Name and Address of Nearest Relative Not Living with you
Relationship
Home Phone
Other Reference

Name and Address of Nearest Relative Not Living with you
Relationship
Home Phone
What You Owe Creditor name other than this credit union
(Attach additional sheet(s) if necessary) 		Interest Rate Present Balance Monthly Payment Owed by
  Applicant Other
Rent 1st Mortgage (include Tax and Ins.)
2nd Mortgage
1st Auto Loan
2nd Auto Loan
Child-Care
Child Support
Credit Card
Credit Card1
Other
Other1
List any names under which your credit references and credit history can be checked. Totals:
What You Own List location of property or financial institution Market
Value		 Pledged as collateral for another loan Owned by
  Applicant Other
Home YES NO
Auto YES NO
Savings YES NO
Checking YES NO
Other (Describe) YES NO
Other Information
About You 		If you answer "Yes" to any question other than #1,
explain in the text box below. 		Applicant Other
  YES NO YES NO
1. Are you a U.S. citizen or permanent resident alien?
2. Do you currently have any outstanding judgments or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit?
3. Is your income likely to decline in the next two years?
4. Are you a co-maker, co-signer or guarantor on any loan not listed above?
      For Whom (Name of Others Obligated on Loan):         To Whom (Name of Creditor):                           
Explanation:

FOR CREDIT UNION USE ONLY
REPAYMENT TERMS
 
Daily Periodic Rate
Annual Percentage Rate

% 
 		Fixed
Variable
 Other Fees (Amount and Description)
$
 		New Balance
$
Amount Advanced
$


 		Payment Amount
$
Date Due
Payment Frequency
Line of Credit Limit
$
 		Remaining Limit
$



SECURITY OFFERED CONSUMERS' CLAIMS AND DEFENSES
The advance is secured by your shares. All property securing other plan advances and loans received in the past or in the future and the following property:
Property/Model Year I.D. Number Value


     


     


     


     


     
Pledge of Shares and/or deposits $ Account Number(s)

Signatures
You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. If there are any important changes you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, renewal or extension of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.

_________________________________
Applicant


_________________________________
Date
_________________________________
Co-Applicant/Spouse/Guarantor


_________________________________
Date


Print this page for your records
Print Application

- PLEASE PRINT THEN SIGN AND FAX APPLICATION TO 1-757-893-9144.
Or
- PRESS SUBMIT TO SEND AN ELECTRONIC COPY TO THE CREDIT UNION.




PEOPLE HELPING PEOPLE STAR P.O. Box 12719 STAR Norfolk, VA 23541-0719 STAR phone: 757.461.1796 STAR toll-free: 800.335.1796 STAR fax: 757.893.9144
 

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