Credit Builder Loan Intake

Complete this form to get started with ProsperUs Detroit’s Credit Builder Loan in collaboration with One Detroit Credit Union!

First Name of Primary Account Owner

Last Name of Primary Account Owner

Preferred Method of Communication

Phone

Birth Date

Social Security Number (or ITIN)

Picture Identification Number

Passport, Driver’s License, State ID, Permanent Resident Card, City of Detroit ID, or another official form of picture ID

ID Expiration Date

Mother’s Maiden Name

Will you have an additional signer on this account?

No, I do not have an additional signer(s)Yes, I will have an additional signer and need to share their information.

Current Residential Address

Mailing Street

City

State

Postal Code

Do you own or rent your place of residence?

OwnRent We consider paying a mortgage or participating in a land contract “owning” your home.

How much is your monthly mortgage payment or rent?

How long have you lived in your place of residence?

Business Information

Do you currently operate a business?

Business Name

Select the industry that most closely aligns with your business or business idea:

What “other” industry most closely aligns with your business or idea?

Loan Type

Credit Builder

Loan Amount Needed

Additional Signer

First Name of Secondary Account Owner

Last Name of Secondary Account Owner

Preferred Method of Communication

Phone

Birth Date

Social Security Number (or ITIN)

Picture Identification Number

Passport, Driver’s License, State ID, Permanent Resident Card, City of Detroit ID, or another official form of picture ID

ID Expiration Date

Mother’s Maiden Name

Demographic Information for Additional Signer

ProsperUs Detroit greatly values you sharing any personal demographic information. Unless specified by you, your information will remain private to ProsperUs Detroit’s database and shared only in aggregate with necessary funding partners. Knowing more about the people we serve is pivotal in providing meaningful and intentional access to opportunities for entrepreneurs and their businesses.

How would you describe yourself?

Please describe:

To which gender identity do you most identify?

If you’re comfortable, please share more about your gender identity:

Country of Birth

Have you or your spouse ever served on active duty in the U.S. Armed forces?

What is the size of your household (all members including yourself)?

Please share your annual household income (all sources combined):

Do you have any prior experiences with the justice system?

ProsperUs does not discriminate justice involved individuals. This information is important to our team as we create and share resources with entrepreneurs with these experiences.

Primary Account Owner Employment Information

Current Employer

If you’re unemployed or not formally employed, write “self-employed.”

Employer Address Information

Employer Street Address

City

State

Postal Code

Phone

How long have you you worked for this employer?

Primary Identification Upload

Acceptable Forms of Identification

State-Issued Driver’s License
State-Issued Identification Card
United States Passport or ID Card
Permanent Resident Card
City of Detroit Identification Card

An account with One Detroit Credit Union requires a clear image of the front and back of your selected identification. There are fields below to upload the images as a PDF, JPEG, or PNG file.

To upload your file, select the “Choose File” button and your file manager will appear. Select the file you wish to share. Once you’re comfortable with the files you chose, press “Next Page” and complete the rest of the form.

Upload Image of Front of Identification

Upload Image of Back of Identification

Media Consent

We believe you are capable of accomplishing the goals you set for yourself. Sometimes, we want to share your success story with our partners and the wider community. This form allows us to share the outcomes of your hard work.

I hereby authorize ProsperUs to develop and use the following:

Interview of my story

Video-tape of my image and voice (including digital)

Audio-tape of my voice

Photograph of my image

Other

Enter “Other” authorizations here

I understand that the above checked items will be used for promotional, journalistic and/or educational material including use on the internet. I hereby give my consent to be named in the photographs, video images, or other images made of me or my family member(s). I also consent to interviews with a representative of ProsperUs and/or a member of the new media. I understand and agree that these materials may be used by the news media or by ProsperUs for the purpose outlined above

Photograph and video image releases include (i) unconditional, royalty-free and irrevocable authorization and consent for the use of such photographs, video images and materials, by ProsperUs; and (ii) releases ProsperUs and its affiliates from any liability for the use of such photographs, video images and materials (including from any claims of distortion, illusionary effect, libel, or of violations of any right of publicity or privacy). If an individual under the age of 18 is prominently featured in a photograph or video image, the organization shall ensure that a photograph and video image release is duly executed by a parent or legal guardian of such individual.

I understand that I may revoke this consent at any time except to the extent that action based on this consent has been taken. This authorization is fully understood and is made voluntarily on my part.

Without revocation, this consent is ongoing until revoked in writing.

Type your full name here to authorize the above-checked releases

Date

Release of Information

I authorize ProsperUs Detroit to collaborate and release information in order to enhance my overall experience.

I also understand that financial coaching services offered through ProsperUs Detroit are voluntary and separate from engagement with other ProsperUs Detroit program, and all information about my financial situation will be held in strict confidence.

Type your full name here to authorize release of information

Date

We review Credit Builder Loan intakes on a rolling basis. We can't wait to continue to collaborate on your financial goals.

COMPLETE CREDIT BUILDER LOAN INTAKE

Current Residential Address

Business Information

Additional Signer

Demographic Information for Additional Signer

Primary Account Owner Employment Information

Primary Identification Upload

Acceptable Forms of Identification

Media Consent

Release of Information

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