Sydenham Community Credit Union

Credit Application Form

This form is intended for either online submission or completion, printing and sending to Sydenham Community Credit Union - Fax, mail or in person.

Fax Information:

Head Office and Branch: 1-519-245-0167
Lambeth - Branch: 1-519-652-0420
Mt. Brydges - Branch: 1-519-264-9181
Parkhill - Branch: 1-519-294-0521
Strathroy - Branch: 1-519-245-6728
Ailsa Craig - Branch: 1-519-293-3454

Personal Loan Application Line of Credit Application (regular or MeritLine) Mortgage Application
Mr. Mrs. Ms Miss

Last Name:
First Name:
S.I.N. Number:
Date of Birth(mm/dd/yyyy):
Street:
City / Province:
Postal Code:
# of Years At Residence:
Home Telephone:
Marital Status:
# of Dependent Children:
Are You Currently a Member?:	Yes No
If so, at Which Branch?:

Employment

Employer:
Job Title:
Work Address:
Work Phone:
E-mail Address:
How Long Have You Been There:
Gross Income:
Previous Employer:
Street:
City/Province:
Job Title:
How Long Were You There:

Spouse (if applicable):

Mr. Mrs. Ms Miss

Last Name:
First Name:
S.I.N. Number:
D.O.B. (mm/dd/yyyy):

Employment

Employer:
Job Title:
Work Address:
Work Phone:
E-mail Address:
How Long Have You Been There:
Gross Income:
Previous Employer:
Street:
City/Province:
Job Title:
How Long Were You There:

Combined Assets

Item	Description	Value
Real Estate:
Automobiles:
RRSPs:
Stocks / Bonds:
Second Property:
Other Assets:

Bank Accounts:
Financial Institution:
Financial Institution Location:

Combined Liabilities

Item	Description	Amount Outstanding	Monthly Payment
Mortgage:
Personal Loans:
Credit Cards:

NOTE:

You must be a Member and Canadian resident to qualify for a loan.
Contact your Credit Union for further details.

Please Select all that apply:

This is an application for a loan to be issued in my name only
This is an application for a loan to be issued jointly with my spouse
This is an application to guarantee or consign a loan for:

Application Details

Amount required ($):
Payment Amount ($):
Repayment Period (months):
Purpose of the Loan:
E-Mail Address:
Phone # (Home):
Fax # (Home):
Phone # (Work):
Fax # (Work):

Declaration and Authority to Obtain Information

By selecting "Yes" in the box below, I / we acknowledge that:

Yes, I / we acknowledge that:

The Credit Union may obtain information about me and / or my spouse, from my / our employer, and credit bureau and any other person in connection with any of my / our dealings with the Credit Union and the Credit Union may disclose (automatically or upon request) credit information about me / us to credit bureaus and persons with whom I / we have or propose to have financial dealings, if the Credit Union believes disclosure is required by law.

I / we certify that the information in this application is true and correct and that each asset is shown at its present fair market value and I / we own all such assets. If any or part of this statment is incorrect or if there is a breach of this agreement, then I / we hereby agree with the Credit Union that all my / our present and future idebtedness to the Credit Union shall become due and payable without notice of demand.

If you agree with the outlined terms above, please sign below:

________________
Applicant

You may fax this to 519 245-0167 or deliver the form to your nearest branch.

Please click the Apply button only once. Thank you !