Military Lending Act Waiver Request Form
Submit your request for a waiver related to covered credit terms under the Military Lending Act. Please complete all required fields to ensure accurate and timely processing.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Service Member Status
*
Active Duty
Reserve
National Guard
Dependent/Spouse
Other
Account Reference (Last 4 Digits Only)
*
Type of Covered Credit
*
Please Select
Personal Loan
Auto Loan
Credit Card
Line of Credit
Other
Waiver Request Details
*
Reason for Waiver Request
Signature
*
Submit Waiver Request
Submit Waiver Request
Should be Empty: