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Services Online Loan Application

Please complete all your details in the form below, and click submit when you have finished.

Online Loan Application
* Required Fields
Account Number:  *
Member Name:  *
Member Address:  *
Previous Address (If less than 3 years): 
Type of Accommodation:  *
If Other, please specify: 
Tel Home:  *
Tel Work: 
E-mail Address:  *
Date of Birth:  *
Marital Status:  *
Number of Dependants: 
Employment Details
* Required Fields
Employer:  *
Work Address:  *
Occupation:  *
Length of Service:  *
Weekly Salary:  *
Other Income: 
Spouse/Partners Details (where relevant)
* Required Fields
Spouse/Partners Name: 
Spouse/Partners Employer: 
Employers Address: 
Spouse/Partners Occupation: 
Spouse/Partners Weekly Income: 
Any Other Income: 
Spouse/Partners Date of Birth: 
Current Financial Situation
* Required Fields
I declare that I am indebted to the following:
 
Original AmountBalance OutstandingMonthly Repayment Amount
Bank/Building Society:
Rent/Mortgage:
Credit Card:
Other:
Current Savings Balance(s):  *
Current Loan Balance(s): 
Current Arrears: 
Loan Details
* Required Fields
I wish to apply for a loan of:  *
Purpose of Loan:  *
Date Required:  *
To be repaid every:  *
In installments of:  *
Declaration
* Required Fields
I declare that I am not indebted to any other Credit Union, Bank or Loan Agency either as a borrower or Guarantor, except as stated on this application. The statements herein are made for the purposes of obtaining the loan and are true to the best of my knowlewdge and belief.
I declare that to the best of my knowledge: *


And that: *


ICB Credit Check: *
Signature of Applicant:  *
Date Signed:  *
Data Protection Act 1988 - I consent to the information contained in this application form being used by the Credit Union for the purposes of processing my application
Edenderry Branch
  • Tel:
  • Address:
  • 046 9731755
  • O'Connell Square, Edenderry, Co. Offaly
Coill Dubh Branch
  • Tel:
  • Address:
  • 045 860 554
  • Coill Dubh, Naas Co. Kildare

Clane Carbury Allenwood Prosperous Robertstown

Click here for all branches contact details and opening hours

Croí Laighean Credit Union Ltd is Regulated by the Central Bank of Ireland. Reg No. 163CU