ILA Local 1235 Loan Application

First Name *

Last Name *

Social Security No. *

No dashes, spaces, or parentheses

Date of Birth *

Email *

Phone (Best contact phone #) *

No dashes, spaces, or parentheses

Address *

City *

State *

Zip Code *

Type of Loan *

Amount Requested *

Enter a value no greater than 999,999

Current Employer *

Monthly Income *

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