Apply for a Loan Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information. Loan Information Type of Loan Amount Requested Term How Many? Term Length Will there be a co-applicant on this application? Choose One New Auto Used Auto Motorcycle Recreational Vehicle/Boat Personal Share Secured WCPS Continuing Education $ Select Years Months YesNo Payment Protection Coverage Check coverage(s) desired. We will disclose the cost of this Payment Protection Insurance to you. A separate form which discloses the terms and conditions must be signed for coverage to become effective. Do you want your loan protected for you and your family if you become disabled (Credit Disability)? YesNo Do you want your loan protected for you and your family in the event of your death (Credit Life)? YesNo Do you want your auto loan protected by Guaranteed Asset Protection insurance (GAP)? YesNo Primary Applicant Member Number Last Name First Name Middle Name SSN (TIN) Date of Birth (mm/dd/yyyy) Home Phone Work Phone Cell Phone () -Second partThird part () -Second partThird part () -Second partThird part Email Address Home Address Street City State Zip Code Type of Residence Monthly Payment OwnRentOther $ Time at Current Residence Years: Months: 0 1 2 3 4 5 6 7 8 9 10 11 Present Employer Name Phone Number () -Second partThird part Employment Status Full TimePart TimeTempRetiredOther Other Job Title Job Start Date (mm/dd/yyyy) Gross Salary $ Per Year Month Hour Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Co-Applicant Member Number Last Name First Name Middle Name SSN (TIN) Date Of Birth (mm/dd/yyyy) Home Phone Work Phone Cell Phone () -Second partThird part () -Second partThird part () -Second partThird part Email Address Home Address Street City State Zip Code Type of Residence Monthly Payment OwnRentOther $ Time at Current Residence Years: Months: 0 1 2 3 4 5 6 7 8 9 10 11 Present Employer Name Phone Number () -Second partThird part Employment Status Full TimePart TimeTempRetiredOther Other Job Title Job Start Date (mm/dd/yyyy) Gross Salary $ Per Year Month Hour Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Reference - Nearest Relative Not Living With You Last Name First Name Relationship Phone Number () -Second partThird part Address City State Zip Code Proof of Income Verification Proof of Income from all sources is required prior to loan approval. This can be through your previous year’s W2 or your two most recent pay stubs. You may submit your proof of income in person to any office, or by fax to the Main Office at 1-844-734-2812 or Williamsport at 1-855-735-8331, or by uploading the files below. Upload file Upload file Upload file Upload file Additional Information How would you prefer to be contacted? Home PhoneWork PhoneCell PhoneEmail If approved, where would you like to sign loan documents? Leitersburg PikeWilliamsportCES Special Instructions/Comments Application Submission By clicking Submit below, you promise that everything you have stated in this request is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You also agree to notify us of any change in your name, address, or employment within a reasonable time thereafter. You authorize the Credit Union to obtain credit reports in connection with this request. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on requests made to federal credit unions or state chartered credit unions insured by the NCUA. You also understand that the Credit Union will rely on the information in the request and your credit report to make its decision. Prior to submitting this application, please enter the security code in the box below