Nusenda Credit Union Co-Op Capital Lending Program Application

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)*

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

Select

What is your other involvement with PCA?*

Marital Status (select one)*

Select

Type of Identification*

Select

File Upload

Please upload a copy of your ID below

Drag and drop files here or

ID Number*

What state was the ID issued in?*

Issue date (MM/DD/YYYY)*

Expiration date (MM/DD/YYYY)*

Social Security Number (if none, enter 0)*

ITIN # (if none, enter 0)*

What is your country of origin?*

City*

State*

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*

Adult ages*

Children in household*

Children ages*

Race (select all that apply)*

Select

If applicable, write your affiliation to a tribe/s*

Ethnicity*

Select

Migrant*

Select

Gender*

Select

Employment

Household monthly gross income*

Do you work for a company?*

Select or enter value

Name of the 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*

Select

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).

If this is a business loan you must answer the following questions:

Identify your business (check all that applies)*

Select

Is the business currently operating?*

If your response is yes, what is the name of your business?*

What is the legal structure?*

Select

What was the gross income of last year?*

Address of business*

Specify type of business (restaurant, clothing boutique, gas station)*

Is your business located in Native American land?*

Is business located in Bernalillo County?*

If there is multiple branches, is there one in Bernalillo County?*

Number of employees*

Are you included?*

Number of contractors*

Is this business full time or part time?*

Send me a copy of my responses

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