Nusenda Credit Union Co-Op Capital Lending Program Application

To learn more about Co-Op Capital: https://www.nusendafoundation.org/partner-programs/co-op-capital

Contact Information and Demographic Data

First Name

Last Name

Phone Number

Phone

Date of Birth (MM/DD/YYYY)

mm/dd/yyyy

How are you involved at PCA? (please select all that apply)

Marital Status (select one)

Type of Identification

File Upload

Please upload a copy of your ID below

Drop your files here

ID Number

What state was the ID issued in?

Issue date (MM/DD/YYYY)

mm/dd/yyyy

Expiration date (MM/DD/YYYY)

mm/dd/yyyy

Social Security Number (if none, enter 0)

ITIN # (if none, enter 0)

What is your country of origin?

How many years have you been living in the United States?

Address

City

State

Zip code

Do you own or rent your home?

How many years at this address?

Email address

Number of members in the household?

Adults in household

Children in household

Race (select all that apply)

Ethnicity

Migrant

Gender

Employment

Household monthly gross income

Do you work for a company?

List last three jobs, include dates:

Amount requested for the loan

What is the purpose of loan?

What is the goal you would like to accomplish with this loan?

Do you have membership with Nusenda Credit Union?

Type of loan

Electronic Signature (First and Last Name)

Date

If it is a personal loan, the application ends here. For a business loan, continue with the following questions (they will appear automatically if you select 'Business' under Type of loan).

Send me a copy of my responses

Report Abuse

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.