Open Mon-Wed & Fridays 9:30 AM to 5:00 PM, and on Thursdays 8:30 AM to 6:30PM
Print this Form
*Loan Purpose (in detail)
*Amount of Loan
Personal Information
*Applicant Last Name
*First Name & Initial(s)
Social Insurance No.
Spouse/Joint Last Name
First Name & Initial(s)
Social Insurance No.
Marital Status
No. of Dependants
(excl. spouse)
Ages of Dependants
(seperate with commas)
*Present Address
*Postal Code
*I have lived at my present address since
Rent / Mortgage Payment
Landlord's Name & Address
Previous Address (if less than 3 years at present)
Contact Preference
Contact Time
Personal References (immediate family preferred)
Employment Information
Employer Name & Address
How Long?
Phone No.
Monthly Income $ Gross $ Net Pay Frequency
*Applicant Salary/Wage
Spouse/Joint Salary/Wage
Previous Employer Name & Address (if less than 3 years at present)
How Long?
Name & Address of Spouse/Joint Employer
How Long?
Spouse/Joint Occupation/Position/Retirement
Phone No.
Spouse/Joint Previous Employer (if less than 3 years at present)
How Long?
Financial Information
Assets Market Value Liabilities Limit/High Present Balance Monthly Payment
Total Total Liabilities
Net Worth
Contingent Liabilities - have you co-signed or guaranteed any loans and the amount of these loans?
*Will any account/product under this membership be used by and for the benefit of someone other than the named member(s)?

*Will any accounts/products under this membership be used by a politically exposed foreign person (PEFP)?

In relation to my application for credit or obtaining a loan from the Credit Union, I hereby consent to the Credit Union (including any agent, contractor, professional advisor, or collection agent appointed by the Credit Union, and any assignee of the Credit Union) obtaining the disclosure and release of personal information consisting of my current address, telephone number(s), motor vehicle registrations, credit history or banker's credit references, deposit or investment account or credit information, from any provincial or federal government or any government agency or corporation, any financial institution or party that I have an deposit or investment account with or that has granted me credit, or any credit reporting agency. The credit union is authorized by me to obtain this information for the purpose of determining my qualification for credit, confirming the ownership and description of any collateral assets I am providing as security for my loan and registering a security interest in those assets, locating me for the purpose of matters in relation to my loan including the collection of amounts owed, and the seizure of secured assets. This authorization shall remain in force so long as I have a pending credit application before the Credit Union or an amount owing in relation to a loan by the Credit Union to me. (In this authorization "I, me, or my" refers to the applicant under a credit application, or the borrower under a loan or security agreement, and includes single or multiple persons).

I certify that the information on the application is true and I understand that any mis-statement of fact shall entitle the credit union to require immediate payment of all monies advanced under this loan, together with interest.

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Contact Rocky Credit Union

5035 49 Street
Rocky Mountain House AB  T4T 1C1

P    403 845 2861
F    403 845 7295

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