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Please Direct This Application To: Roseville Branch Brownstown Branch Mt Joy Branch
Check Preference: Credit Life Joint Credit Life Single Credit Disability Life And Credit Disabilty None
Amount Applied For $ For A Term Of Months
Type and Purpose of Loan: (Auto, Signature Line of Credit, Fixed Signature, Home Equity Prime Line of Credit, Fixed Rate Home Equity, Share Secured, Tuition Reimbursement.)
Applicant Account #: Name: Present Address: Street: City: State: Zip: Home Phone #: Cell: Email: Date of Birth(MM/DD/YY): Social Security #: Driver's License #: Own Rent Payment Employer: Phone: Position: Hired: Gross Annual Income: $ Pay Frequency: Weekly Bi-Weekly Semi Monthly Monthly Other Income: $ Income from alimony, child support or maintenance payments need not be revealed if you do not wish to rely upon it to obtain this loan. Nearest Relative: Present Address: Street: City: State: Zip: Have you filed bankruptcy in the last 14 years? No Yes Have you ever had auto, furniture or property repossessed? No Yes Have you ever had credit in any other name? No Yes Do you have any judgments or lawsuits pending? No Yes Do you have any past due bills? No Yes Are you a United States citizen? No Yes	Co-Applicant Account #: Name: Present Address: Street: City: State: Zip: Home Phone #: Cell: Email: Date of Birth(MM/DD/YY): Social Security #: Driver's License #: Own Rent Payment Employer: Phone: Position: Hired: Gross Annual Income: $ Pay Frequency: Weekly Bi-Weekly Semi Monthly Monthly Other Income: $ Income from alimony, child support or maintenance payments need not be revealed if you do not wish to rely upon it to obtain this loan. Nearest Relative: Present Address: Street: City: State: Zip: Have you filed bankruptcy in the last 14 years? No Yes Have you ever had auto, furniture or property repossessed? No Yes Have you ever had credit in any other name? No Yes Do you have any judgments or lawsuits pending? No Yes Do you have any past due bills? No Yes Are you a United States citizen? No Yes
You promise that everything stated in the application is correct to the best of your knowledge and that the above information is a complete listing of all your debts and obligations. You authorize the credit union to obtain credit reports and verify any information in connection with this application. If this is a joint application, you are also authorizing the verification of all co-applicant information. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to Federal Credit Unions insured by NCUA. 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.
Please fax a current pay stub to 717-569-2374 to complete this application.

© LANCO Federal Credit Union
349 West Roseville Rd. Lancaster, PA 17601 717-569-7180 1-888-318-4222	Corner of State & Main Brownstown, PA 17508 717-656-8963	2024 West Main St. Mount. Joy, PA 17552 717-361-1800