Applicant - LG&W Federal Credit Union

First Name*

Middle Name

Last Name*

Gender*

Tax ID Type*

Tax ID*

Driver's License State

Driver's License Number

Driver's License Expiration Date

Home Phone

Cell Phone

NOTE: At least one phone number is required.

Work Phone

Birth Date*

Email Address*

Confirm Email Address*

Current Address

Address 1*

Address 2

City*

State*

Zip Code

Country*

Years at This Address*

Do You Own or Rent?*

What is your Monthly Payment?*

NOTE: If you do not pay rent or own, please select "Other".

NOTE: If your house is paid in full, please enter the total monthly tax & insurance payment.

Previous Address

Address 1*

Address 2

City*

State*

Zip Code

Country*

Who is Your Current Employer?

Employer\Area #

Job Title\Supervisor

NOTE: If you are self employed or retired, enter "Self Employed" or "Retired" under Employer.

Hire Date*

How much do you earn per year?*

Do you have other sources of income?*

Reference

Reference Name*

Relationship*

Reference Address*

Reference City*

Reference State*

Reference Zip Code

Reference Country*

Phone Number of Reference*

Years Known*

LG&W Federal Credit Union

Primary Applicant Information

Current Address

Previous Address

Who is Your Current Employer?

How much do you earn per year?*

Who is Your Previous Employer?

Do you have other sources of income?*

Other Income

Reference

LG&W Federal Credit Union

Inactivity Warning

Primary Applicant Information

Current Address

Previous Address

Who is Your Current Employer?

How much do you earn per year?*

Who is Your Previous Employer?

Do you have other sources of income?*

Other Income

Reference