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Please complete the form below

Personal Details

Title: *
Forename: *
Surname: *
Date of Birth: *
National Insurance: *
Gender: *
Email Address: *
Home Number:
Mobile Number: *
Country of Birth: *
Nationality: *
Residential Status: *
Housing Association: *

Address Details: *

Please add your address history, starting with your most recent. We require either your last 5 addresses or addresses covering the last 3 years.
To add an address, enter and search your postcode, select your address and the date you moved in, and click add.


How did you hear about us?: *
I am related to a member of staff: *
Please enter your referrer's member number

Employment Details

Employment Status: *
Company Name: *
Job Title:
Payroll Number:

Employer Address: 

Payment in Details

How much do you wish to save? *
Min: £1.00 Max: £99,999,999,999.00
How would you like to save? *
Instruction to your Bank or Building Society: Please pay Leeds City Credit Union. Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Leeds City Credit Union. and, if so, details will be passed electronically to my bank/building society.

Please complete the direct debit mandate and select the date you wish your Direct Debit to be collected: *

Payment Date: *
Account holders name: *
Bank Account Number: *
Sort Code: *

I am authorised to set up instructions on this account, with just my signature:*

The Direct Debit Guarantee

  • This guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the scheme is monitored and protected by your own Bank or Building Society.
  • If the amounts to be paid or the payment dates change Leeds City Credit Union will notify you ten working days in advance of your account being debited or as otherwise agreed.
  • If an error is made by Leeds City Credit Union or your Bank or Building Society, you are guaranteed a full and immediate refund from your branch of the amount paid.
  • You can cancel a Direct Debit at any time by writing to your Bank or Building Society. Please send a copy of your letter to us.
How often would you like to make payments: *

Bank Details (For Withdrawals)

Account Holder: *
Sort Code: *
Account: *

Maximum: 3

Marketing Preferences

I wish to be kept up to date by email with our changing products and services.: *
I wish to be kept up to date by SMS with our changing products and services.: *
I wish to be kept up to date by Post with our changing products and services.: *

Loan Application

Do you wish to apply for a loan now?: *


Before applying you must read the FSCS guidance, membership terms and conditions, and any other documents listed. Please click the terms and conditions link below to view these.

I confirm I have read and agreed to the terms and conditions of this application.*
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