College Auto Loan/Credit Card Application
This form serves as a master loan application, covering all loans
offered by Provident except real estate. The information you provide
on this application will be kept permanently on file. We may ask for a
copy of your most recent pay stub or income verification. When you
want to borrow again, just call us with your updated information.
Type of Credit Requested
c College Auto Loan
Amount Requested: $
Term (Years):
($15,000 maximum)
(Up to 5 years)
I would like to make my College Auto Loan payments through:
c Automatic transfer from my Provident account:
(Without automatic transfer, interest rate is 2% higher)
c Checking
c Savings
c Standard monthly billing or coupons
c College Visa Card
Applicant
Member Number:
Marital Status: c Married
c Unmarried
c Separated
Number of Dependents:
Last Name
First Name
M.I.
Social Security Number
Driver’s License/I.D. Number
State
Birth Date
Mother’s Maiden Name
Address
How Long (yrs/mos)
City/State/Zip
Previous Address (if at current address for less than 2 years)
How Long (yrs/mos)
Previous City/State/Zip
Work Phone (Include Area Code)
Home Phone (Include Area Code)
Employer
Job Title
Employer Address
Department
City/State/Zip
Gross Annual Income
Date of Hire
Previous Employer (if current is < 2 yrs)
Previous Work Phone (Include Area Code)
Other Income
Source
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.
c Rent c Own c Live with Parents
Rent/Mortgage Payment:
Co-Applicant/Joint Borrower (if applying for joint credit)
Last Name
First Name
M.I.
Social Security Number
Driver’s License/I.D. Number
State
Birth Date
Mother’s Maiden Name
Address
How Long (yrs/mos)
City/State/Zip
Previous Address (if at current address for less than 2 years)
How Long (yrs/mos)
Previous City