Loan Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Loan Application

Effective January 9, 2024

All Shoshone Credit Loans are to be secured by Shoshone Indian Tribal Benefit (Welfare Benefit)

_______________

Apply for a tribal loan in the amount specified below.
for the purpose specified below.

I will repay the loan on or before the dates below with interest and will execute a promissory note as evidence of the indebtedness. As security, I will obligate my Shoshone Indian Tribal Benefit (WELFARE BENEFIT) or Payroll Withholding.

The Credit Committee will NO longer review or act on

Refinance Loan Applications until further notice.

I understand

Do you currently have active loans?

YES

Clear selection

If YES , you already have a loan, it is likely you will NOT be eligible for another loan

I understand

Loan Amount you are applying for

$250.00 Emergency Loan

Clear selection

Due to the Indian Tribal Benefit decreasing the Credit Committee will not act on any personal loans

I undestand

Clear selection

PURPOSE OF LOAN *

Funeral Expense

Emergency Medical Expense

Emergency Living Expense

EXPLAIN PURPOSE OF THE LOAN & HOW MUCH ARE YOU APPLYING FOR *

HOW WILL YOU BE PAYING BACK THE LOAN? *

Indian Tribal Benefit Deduction (Shoshone Tribal Welfare Benefit)

Tribal Payroll Deduction (Only if you work for Shoshone Tribe or other approved payroll)

Indian Tribal Benefit and Tribal Payroll Deduction

EMAIL ADDRESS (@gmail or @yahoo etc ... )

FIRST NAME *

LAST NAME *

MAILING ADDRESS (P.O. BOX # WHERE YOU GET YOUR MAIL) *

CITY *

STATE *

ZIP CODE *

PHYSICAL ADDRESS

PHYSICAL CITY

PHYSICAL STATE

PHYSICAL ZIP

CONTACT PHONE NUMBER

DATE OF BIRTH *

TRIBAL I.D. ( 282 - U0 - )

Are you currently employed?

Yes

Clear selection

EMPLOYERS NAME

JOB TITLE/POSITION

HOW LONG HAVE YOU BEEN EMPLOYED?

CAN YOU SUBMIT THE MOST RECENT PAY STUB?

Yes , Will fax or email payroll stub to verfiy ability for repayment

No , Not able to at this time

Clear selection

Clear form

Never submit passwords through Google Forms.

This form was created inside of Eastern Shoshone Credit Program.

Does this form look suspicious? Report

Forms