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 fill out this 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. 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. your spouse will use the account, or
  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 separate accounts.
 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		 None
Single Credit Disability Insurance
Single Credit Life Insurance
Joint Credit Life Insurance 		Check coverage 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:
Name
First Name
MI
Last Name
Account Number


 Social Security Number

000-00-0000
Driver's License
Number
State
List ages of dependents not listed by other applicant
(Exclude Self)  
Home Phone

000-000-0000

Business Phone

000-000-0000

 Birth Date
 /  / 
mm  
dd
   yyyy
Present Address
Street
City
State
Zip
Own Rent
Years at this Address
Previous Address
Street
City
State
Zip
Own Rent
Years at this Address
Complete for Joint Credit, Secured Credit or if you live in a community property state:
Married Separated Unmarried
If Single, Divorced, or Widowed, select UNMARRIED
Applicant: Employment / Income
Name of Employer
Address of Employer
 Title/Grade
  		 Start Date

mm/dd/yyyy		 Work hours per week
 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.
  Employment Income
per
per
Net Gross
Source
Military: Is duty station transfer expected
during the next year?
Yes No
Where to
Ending/Separation Date
mm/dd/yyyy
Previous employer name and address
if employed less than five years
Starting Date

mm/dd/yyyy
Ending Date

mm/dd/yyyy
Applicant: Reference
Name and address of nearest relative not living with you
Relationship
Home Phone

000-000-0000
 
Other: None Co-Applicant Spouse Guarantor
Name
First Name
MI
Last Name
Account Number


 Social Security Number

000-00-0000
Driver's License
Number
State
List ages of dependents not listed by other applicant
(Exclude Self)  
Home Phone

000-000-0000

Business Phone

000-000-0000

 Birth Date
 /  / 
mm  
dd
   yyyy
Present Address
Street
City
State
Zip
Own Rent
Years at this Address
Previous Address
Street
City
State
Zip
Own Rent
Years at this Address
Complete for Joint Credit, Secured Credit or if you live in a community property state:
Married Separated Unmarried
If Single, Divorced, or Widowed, select UNMARRIED
Other: Employment / Income
Name of Employer
Address of Employer
 Title/Grade
 
 Start Date

mm/dd/yyyy
 Work hours per week
 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.
  Employment Income
per
per
Net Gross
Source
Military: Is duty station transfer expected
during the next year?
Yes No
Where to
Ending/Separation Date
mm/dd/yyyy
Previous employer name and address
if employed less than five years
Starting Date

mm/dd/yyyy
Ending Date

mm/dd/yyyy
Other: Reference
Name and address of nearest relative not living with you
Relationship
Home Phone

000-000-0000
What You Owe
Creditor name other than this credit union Interest Rate Present Balance Monthly Payment Owed by
Applicant
Other
Rent or
1st Mortgage
(include tax and insurance.)
2nd Mortgage
1st Auto Loan
2nd Auto Loan
Child-Care
Child Support
Credit Card
Credit Card 2
Other
Other 2
  Totals    
What You Own List location of property or financial institution. Market Value Pledged as collateral for another loan. Owned by
Yes No Applicant Other
Home
Auto
Savings
Checking
Other (Describe)
Other Information
About You 		If you answer "Yes" to any question other than #1, please 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


Signatures
By submitting this application, 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.