Savings Incentive Program

1
Name* This field is required.REMINDER: IF YOU PLAN TO USE ZELLE TO RECEIVE YOUR BONUS YOU MUST HAVE IT SET UP AND HAVE YOUR ACCOUNT INFORMATION ON HAND BEFORE STARTING THIS APPLICATION.
First Name
Last Name
2
Email Address* This field is required.
3
What organization provided your loan?* This field is required.
4
What organization provided your loan?* This field is required.
Please Select
Please Select
ActivateWork
Apartment Life
BEST-CCW
Big Brothers, Big Sisters of Ventura County
Bleu Door Bakery & Cafe
Boys & Girls Club of Greater Oxnard & Port Hueneme
CDM CareGiving Services
Center for Community Wealth
Century FCU
Feeding Anchors-CCW
Greater Vancouver Chamber
Housing Connector-Employees
Highmark Federal Credit Union
Impact Finance Center
Interra Credit Union
LIV Development/Goodfield Foundation
Lookout Credit Union
Marine Credit Union
Metro Credit Union
Northwest Association for Blind Athletes
OceanAir FCU
On-Line Support, Inc.
Ownership Works
Partners in Careers
Pitt Ohio
Rivermark Credit Union
Riverview Bank
Royal Oaks Country Club
Sundance Apartments (Common Capital)
The Republic of Tea
The Source
Treymore Apts. (Apartment Life)
Tucoemas Credit Union
University of Nebraska FCU
University of Nebraska-Lincoln
Vantage West Credit Union
Velera
Vista del Sol Apartments (Common Capital)
WEOKIE Federal Credit Union
Worker Co-op Peer Network-CCW
5
Are you currently employed or affiliated with this organization through a program sponsorship relationship?* This field is required.
Yes
No
6
What was the amount of your loan?* This field is required.Ex. $1000
7
Have you fully paid off you loan and reached the required savings goal of 10% of your total loan amount?* This field is required.Ex. If you paid off a $1000 loan, you need to save at least $100 in your Savings Account.
Yes
No
8
Loan Repayment Date* This field is required.To qualify for the savings incentive you must have already fully repaid your loan and complete the requirement of savings at least 10% of your total loan within 90 days of paying off your loan. Enter the date your final payment was posted to your loan. You can refer to the email you received confirming your loan payoff for this date.
Month
Day
Year
9
At which bank is your savings account held? * This field is required.To receive your Savings Incentive Bonus you are required to have a Savings Account.
Name of Bank or Credit Union
10
Upload Savings Account Statement * This field is required.Please upload a copy of your most recent savings account statement that shows a balance equal to at least 10% of your loan amount. Please make sure that your full name is visible on the statement. You can upload multiple files if needed including pictures of your statement.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
11
How would you like to receive your Savings Incentive Bonus?* This field is required.You can receive your bonus via Zelle or mailed check.
Please Select
Please Select
Online Payment through Zelle (1-2 business days - You must have a Zelle account to receive.)
Check via Mail (Please note: It can take up to 7 business days to receive a check.)
12
Zelle Account Phone Number * This field is required.Be sure to use the same phone number you used when setting up your ZELLE account.
Please enter a valid phone number.
13
Zelle Account Email* This field is required.Be sure to use the same email you used when setting up your ZELLE account.
example@example.com
14
Mailing Address* This field is required.Please provide your mailing address so we can mail you your Savings Incentive Bonus check.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
15
In a few sentences, tell us how your Impact Loan helped you.* This field is required.
16
Signature* This field is required.By signing this, you are affirming that all the information provided is true and accurate.
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