Secure Consumer Loan Application Form

Privacy Policy:
Our privacy policy protects the privacy of your personally-identifying information that you provide us online.

Important Information about Procedures for Opening a New Account
Identification Procedures Requirements: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

Security Notice:
You should ONLY fill out this form on-line if you are using a browser with the latest security enhancements.

1. Complete the form and click "Submit" or print and fax it to 480-281-8222.
2. To safeguard your privacy, QUIT your browser and restart it again after using this form. This form is NOT saved in your computer's memory when you quit your browser.

Please Note:
Information requested with an * (asterisk) must be completed for your application to be processed.

*Application Type
Personal/Consumer Vehicle
Residential Credit Card

*Applicant First Name:
*Applicant Last Name:
*Social Security #:
*Date of Birth:
*Primary Home Phone:
*Email Address:
Co-Applicant Name:
Co-Applicant Date of Birth:
Co-Applicant Social Security #:

Please tell us how we can customize a loan for you:

* By clicking submit, the applicant authorizes review of his/her personal credit profile from a national credit bureau.

Goldwater Bank
7135 E. Camelback Road, Suite I-201
Scottsdale, AZ 85251

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