Economic Hardship Declaration Form

In an effort to support our Members who are experiencing a financial hardship, we encourage any Member who is experiencing a financial hardship to contact Vantage West Credit Union so we can address your individual financial situation and understand what assistance may be available to you. In order to better prepare a Vantage West Associate to assist you, please complete the following Economic Hardship Declaration.
Account Type (If you have both a Consumer and Business relationship, please complete a form for each) *
Products *
Please use whole numbers (no cents) when using currency.
Are you currently employed? *
Are you self-employed? *
Do you own any property free and clear? (homes, vehicles, ATV's, boats, etc.) *
Do you currently own or rent your residence? *
Does your housing expenses include insurance and taxes? *
Do you pay HOA dues? *
Monthly Auto Loan payments (please add each vehicle loan)
List any credit/loan obligations not covered above and the monthly expense for each obligation
Do you currently have medical/dental coverage through your employer? *

All loan modifications are subject to Member eligibility, credit union approval, completion of applicable loan documentation, and production of supporting information. Interest continues to accrue during any accommodation. Members are responsible for separately cancelling and/or modifying all automatic transfers and payments. Vantage West reserves all rights and remedies. Submission of this request may result in an inquiry and review of credit reporting for all Members listed on the loan.

This request is due to an economic hardship. The statements made are true and correct. *
Powered byFormsite