Payday Loan Alternative Credit Union Emergency Loan Application

Payday Loan Alternative Credit Union Emergency Loan Application — Form Fields

This finance template includes 10 fields. Apply for a credit union emergency small-dollar loan as an alternative to payday lending. Free to customize and use on ZenBuild.

• Full Name (text, required)
• Email (email, required)
• Phone Number (text, required)
• Membership Account Number (if member) (text, optional)
• Monthly Net Income ($) (number, required)
• Loan Amount Requested ($) (number, required)
• Loan Purpose (dropdown selection, required) — options: Utility Bill, Car Repair, Medical Bill, Rent, Food, Other Emergency
• Requested Term (dropdown selection, required) — options: 1 Month, 2 Months, 3 Months, 6 Months, 12 Months
• Member for More Than 30 Days? (multiple choice, required) — options: Yes, No - New Member
• Direct Deposit to This Credit Union? (multiple choice, required) — options: Yes, No