Rose City Federal Credit Union
Enrollment     Contact Us
Online Loan Request
Please provide all the requested information.When you have completed the form, press the Submit button to send your application. You'll hear back from us in one to two working days.
* = Required Information
Type of loan requested*  
Amount Requested*  

Primary Applicant
Account Number*  
Last Name*
First Name*
Date of Birth (mm/dd/yyyy)*  /  / 
Home Phone*
Zip Code*
E-mail Address
Employer Name
Employer Phone Number
Job Start Date
Annual Gross Income
Job Title

Joint Applicant (if applicable)
Account Number  
Last Name
First Name
Date of Birth   /  / 
Home Phone
Zip Code
Employer Name
Employer Phone Number
Job Start Date
Annual Gross Income
Job Title

Debts Monthly Payment

Additional Information
Cell Phone  
In addition to Rent/Mortgage, list all other debts; (for example, auto loans, credit card, second mortgage, alimony, child support, auto insurance, IRS liabilities, etc.). Please use a separate line for each credit card and auto loan.

Please note: Income verification is required; other information may be required.

Alimony, child support, or separate maintenance need not be listed unless you choose to have such income considered regarding extension and repayment of the credit requested.

I certify that statements on this application are true and complete. I authorize any person, association, firm, or corporation to furnish on request of this Credit Union, information concerning me or my affairs. (sec. 1014, Title 13, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application of a Federal Credit Union.)