EmailMe Form - CWC Loan Check Request Form

Date of Request

MM / DD / YYYY

Senior Financial Advisor

First Last

Email

Make Check Payable to:

Amount of Check

$ Dollars . Cents

CWC Account to Debit

Opportunity Loan Fund Checking

Goodwill Emergency Loan Checking

JCSU Credit Builder loan

Elevation

Memo line - Should include client name and Loan #

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Loan #

Amount of Loan

$ Dollars . Cents

Amount of Prepaid Interest

$ Dollars . Cents

Purpose

Requested by

Approved by

Completed by

Check Number