Please enter the details requested on this form to apply for your loan. If you are unsure of your membership number, please contact us:
Llanelli: 5-7 John Street, Llanelli, SA15 1UH Tel. 01554 770867
Haverfordwest: 16 Market Street, Haverfordwest, SA61 1NH Tel. 01437 766114
Pembroke Dock: 18 Meyrick Street, Pembroke Dock, SA72 6UT Tel. 01646 682389
Cardigan: 36 Pendre, Cardigan, SA43 1JS Tel. 01239 614868
Carmarthen: Unit 3, Darkgate Offices, SA31 1QL Tel. 01554 770867
Date of birth
Current Address (including postcode)
How long have you lived at your current address?
for less than 1 year
for 1 year
for 2 years
for 3 years
for 4 years
for 5 years
for 6 years
for 7 years
for 8 years
for 9 years
for 10 years +
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