Home » Loan Request Form
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Primary Member Number:
First Name:
Last Name:
Date of birth:
Social Security Number:
Mailing Address:
Apt/Suite Number:
Mother's Maiden Name:
Daytime Phone:
Evening Phone:
Cellular Phone:
Housing Information:
Mortgage Holder or Landlord:
Number of Years Lived at Address:
Monthly Rent/Mortgage Payment:
Driver's License No:
Driver's License State Issued:
Current Employer:
Gross Monthly Income:
Employer's Address:
Employer's Phone No.:
If you wish to have a joint owner on this loan, please enter the joint information below:
Joint Owner's Name:
Joint Owner's Social Security No.:
Joint Owner's Date of birth:
Joint Owner's Phone No.:
Joint Owner's Address:
Joint Owner's Driver's License:
Joint Owner's Driver's License State:


Type of Loan Requested:
Requested Loan Amount:
Requested Loan Term:

The above information is given for the purpose of applying for a Discovery Federal Credit Union Loan and obtaining/updating credit. By submitting, I/We certify under penalties of perjury that: I/We am within the field of Membership of this Credit Union; the information provided on this application is true and correct; and my/our signature on this application applies to all accounts under my/our name at this Credit Union. I/We also agree to be bound to the terms and conditions of any account that I/We have at the Credit Union now or in the future. I/We authorize the Credit Union to obtain information from any source concerning statements made herein. If this application is accepted, I/We promise to pay all charges incurred and agree to be bound by the terms and conditions of the applicable Membership and loan disclosures, which I/We will or have received and retained. If I/We am in default on a financial obligation to Discovery FCU, federal law gives them the right to apply the balance of shares and dividends in my/our account(s) at the time of default to satisfy that obligation. Once I/We am in default, Discovery FCU may exercise this right without further notice to me/us. Credit is subject upon approval. I/We will refer to a current Share Account Rate Sheet, Membership Disclosure, Fee Schedule, Loan Rate Sheet and Loan Disclosure. A current credit report will be obtained on the applicant listed to verify debt.

Joint Account Holder Agreement. By submitting this enrollment application and providing the requested information for a Joint account, Discovery FCU is hereby authorized to recognize any of the account owners subscribed hereto in the payment of funds or the transaction of any business for this account. The joint owners of this account hereby agree with each other and with Discovery FCU that all sums now paid in on shares, or heretofore or hereafter paid in shares by any or all said joint owners to their credit as such owners with all accumulations thereon, are and shall be owned by them jointly, with right of survivorship and be subject to the withdrawal or receipt of any of them, and payment to any of them or the survivor or survivors shall be valid and discharge Discovery FCU from any liability for such payment. The joint owners also agree to the terms and conditions of the account as established by the credit union. Any or all said joint owners may pledge all or any part of the shares in this account as collateral security to a loan or loans from this credit union. The right or authority of the credit union under this agreement shall be changed or terminated by said owners, or any of them except by written notice to Discovery FCU which shall not affect transactions theretofore made.

By submitting this application, I/We certify under penalties of perjury that (1) the Taxpayer Identification Number (TIN) shown on this form is my/our correct TIN and I/We am a U.S. person or resident alien, and I/We am not subject to backup withholding either because (a) I/We have not been notified by the Internal Revenue Service that I/We am subject to backup withholding as a result of a failure to report all interest or dividends or (b) the IRS has notified me that I/We am no longer subject to backup withholding. The Internal Revenue Service does not require my/our consent to any provision of this document other than the certifications required to avoid backup withholding.


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2744 Century Blvd., Wyomissing, PA 19610|tel 610.372.8010|fax 610.372.8105|ABA Routing #231385646
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