(716) 771-5000 Routing #: 222382739 1937 Union Road, West Seneca, NY 14224 M – F: 8:30 AM – 5 PM. Sat: 9am-12pm (Drive Thru Only) Like Us on Facebook 24 Hour Debit Card Services 1-833-574-3422

WNY FCU Loan Application

Will this be a Single or Joint Application?*

Single Application

Joint Application

How did you hear about us?*

Phone (Best contact phone #)*

No dashes, spaces, or parentheses

VIN #

Make

Model

Year

Mileage

Loan Term (in months)*

Amount Requested*

Enter a value no greater than 999,999

Primary Applicant - Personal information

Social Security No.*

No dashes, spaces, or parentheses

Driver's License No.*

No dashes, spaces, or parentheses

Driver's License State *

Date of Birth *

Address *

Address 2

City *

State *

Zip Code *

Years There *

Previous Address (if less than 2 years at present address)

Address 2

City

State

Zip Code

Years There

No. of Dependents *

Complete for joint credit, secured credit, or if you live in a community property state *

I am Single

I am Married

I am Separated

Employment information

Current Employer *

Position *

Annual Income *

Employee Start Date *

Reference

Name of nearest relative not living with you *

Relatives Address *

Address 2

City *

State *

Zip Code *

Relationship *

Phone *

No dashes, spaces, or parentheses

Joint Applicant - Personal information

First Name*

Last Name*

Email*

Phone (Best contact phone #)*

No dashes, spaces, or parentheses

Social Security No.*

No dashes, spaces, or parentheses

Driver's License No.*

No dashes, spaces, or parentheses

Driver's License State *

Date of Birth *

Address *

Address 2

City *

State *

Zip Code *

Years There *

No. of Dependents *

Complete for joint credit, secured credit, or if you live in a community property state *

I am Single

I am Married

I am Separated

Employment information

Current Employer *

Position *

Annual Income *

Employee Start Date *

Reference

Name of nearest relative not living with you *

Relatives Address *

Address 2

City *

State *

Zip Code *

Relationship *

Phone *

No dashes, spaces, or parentheses

Disclosure and Agreement to Terms

I hereby certify that all information contained in the application is furnished for the purpose of obtaining the loan requested herein and is true to the best of my knowledge and belief. I further certify that no consideration has passed or will pass from me, as borrower, to an endorser for his endorsement or to co-maker for his/her signature. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. I have assisted the Credit Union in the preparation of this application; I have provided the Credit Union with all of the information contained therein; I hereby certify that this loan application is truthful and complete to the best of my knowledge and that I have read the entire completed application before signing same.

Do you agree with the above terms and conditions? *

Yes, I agree to the terms

No, I do not agree to the terms

Signature (type your full name) *

Date *

Upload the most recent copy of your paystub

Co-Applicant

Do you agree with the above terms and conditions? *

Yes, I agree to the terms

No, I do not agree to the terms

Signature (type your full name) *

Date *

Co-Applicant: Upload the most recent copy of your paystub