Does your member want to meet in person? * Credit Union Employee Information:

Employee First Name *

Employee Last Name *

Employee Title *

Employee Email *

Please Select Your Lake Trust Branch Location * Member Information:

Loan Type *

First Name *

Last Name *

Phone Number *

Phone Number is Landline? Yes

Email - If the member does not have an email, please use FirstnameLastname@mtg-ctr.com (i.e. JohnDoe@mtg-ctr.com). *

Current Street Address

City

State *

Postal Code

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