Mercy Financials Membership Form

بِسْمِ اللَّهِ الرَّحْمَٰنِ الرَّحِيمِ

Assalamu Alaikum! Welcome to the membership arena of Mercy Financials. You are just one step away to become a registered member! Mercy Financials is a US non-profit organization registered in the State of Texas (check the Status). Mercy is giving you a unique opportunity to save and get interest-free loans whenever you need them. Your savings could start from as low as $50/month. Please visit www.mercyfi.com, read the Bylaws, contact the board, or email mercyfinancials@gmail.com should you have any questions. And, jump in-----
Membership Application
*Office Use Only:
The Status of Application is-
Authorized Membership ID
Membership Valid Thru-

MonthDayYear
Date
Board Representative Signature
Personal Information
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Current Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Please upload a copy of your valid Driving License or Govt. Issued ID (Passport/State ID):*

Browse Files
Max Size 1500 KB Cancelof
Emergency Contact
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Email
example@example.com
Membership Questions
Date when your membership begins (if different than today)?

MonthDayYear
Date
Please provide at least one reference of any standing member:*

Full Name Contact Number
How much you're planning to save each month with Mercy Financials?*
Feedback
Will you be willing to recommend Mercy Financials?*

YesMay BeNo
Who do you would like to refer Mercy Financials:

Full Name Email
Any Feedback/Comment is appreciated:
Suggestions (if any) for further improvement:
Acknowledgment and Signature
Signature*
Date*

MonthDayYear
Date
Payment

The application fee ($20) is due at sign-up. The membership fee ($2/month) for the remaining months of this year and the first-month installment (min. $50) are recommended due if the application is approved.

Method of payment- You can pay from your PayPal a/c by clicking here or sending the Paypal payment directly to 'mercyfinancials@gmail.com '.

Please make the payment and redirect it here to finish the application. Don't forget to write a note on the payment for your record.
I've made the payment and the amount paid is?*

$20 for Application onlyOther
Please provide the Paypal transaction no. for the payment-*
Should be Empty: