Shoshone Tribal Credit Office Online Loan Application
16 North Fork Rd
P.O. Box 398
Fort Washakie WY 82514
P: 307-332-2920
F: 307-335-8978

I would like to apply for a tribal loan in the amount specified below.
[Up to $350.00 if using Per Capita Withholding] or [Up to $500.00 if using Tribal Payroll Withholding]
for the purpose specified below; of which shall be advanced to me by check.
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 Per Capita or Payroll Withholding.

DATE OF LOAN *
MM
/
DD
/
YYYY
FIRST NAME *
Your answer
LAST NAME *
Your answer
PURPOSE OF LOAN *
Do you currently have active loans? *
EXPLAIN PURPOSE IF NEEDED *
Your answer
DO YOU HAVE PROOF OF PURPOSE?
Loan Amount Specified *
HOW WILL YOU BE PAYING BACK THE LOAN? *
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