test validation
bypass validation
* indicates a required field
*
First Name
*
Last Name
*
Are you a BFCU member?
Yes
No
*
Loan Purpose
*
Loan Amount
*
Business Name
Tax ID Number (if applicable)
SSN (if business is a DBA)
*
Is Busines a Start Up?
Yes
No
*
Length of Time in Business
*
Business Address
*
City
,
State
Zip
*
City
*
State
*
Zip
*
Business Phone Number
*
Business Type
*
Number of Employees
*
Owner/Principal Name
*
Ownership %
*
Social Security Number
*
Date of Birth
*
Home Address
*
City
,
State
Zip
*
City
*
State
*
Zip
*
Best Contact Number
*
Email Address
Select Your Preferred BFCU Location:
Airline Center
Alexandria Center
Blanchard Center
BX Center
Cotton Valley Center
Deridder Center
Eastbank Center
Ellerbe Center
Fort Polk Center
Hodge Center
Leesville Center
Linton Center
Longview Skyline Center
Mansfield Road Center
Market Street Center
McCann Center
North Market Center
Northgate Center
Oakdale Center
Pines Road Center
South Bossier Center
Stockwell Center
Youree Drive Center
* indicates a required field