Font Size:
A
A
  • Home
  • Contact
  • Blog
  • Donate
Pennsylvania Assistive Technology Foundation
Menu
  • Who We Are
    • About PATF
    • What is Assistive Technology?
    • Board of Directors
    • Staff
    • Join Our Team
    • Publications
    • Appalachian Assistive Technology Loan Fund (AATLF) Program
  • What We Do
    • Our Programs
    • Financial Loans
    • Information & Assistance
    • Financial Education
    • Community HealthChoices Toolkit
    • Money Talks Webinar Series
    • Smart Home Technology Project
    • Vision for the Future Conference
    • Success Stories
  • Resources
    • PATF Materials
    • Additional Resources
    • Retailers
  • Apply
    • How to Apply
    • Loan FAQs
    • Download Application
    • Apply Online
  • Newsletter Signup

Apply Online Test

1Loan Application Checklist
2Section A - Privacy Statement and Notice
3Section B – Loan Request
4Section C – Applicant Information
5Section D – Co-Applicant Information (If Applicable)
6Section E – Marital Status
7Section F – Income & Expenses
8Section G – Assistive Technology and User
9Section H – Review and Sign
10Section I – Certification
11Section J – Review Application
  • To ensure that your loan will be processed in a timely manner, be sure to complete the application in its entirety and to submit all the required documentation listed below.

    PATF will NOT reimburse for a device you have already purchased.

    You can mail, email, or fax the following items to complete your application. Additional documents may be required.

    The following is required for both applicants and co-applicants:
    1. Your Social Security Number. You must call, mail, or fax PATF with this information.
    2. Two copies of identification; one required to be a Photo ID
      Examples include:
      • Driver’s license with current address (Photo ID)
      • Non-driver’s ID with current address (Photo ID)
      • Passport (Photo ID)
      • Utility bill with current address
      • Medical insurance card
      • Social Security card
    3. Proof of income
      Examples include:
      • Two current paystubs and two most recent W-2s
      • IRS Tax Return for the past two years (if self-employed)
      • Supplemental Security Income (SSI) benefit verification letter
      • Social Security Disability Insurance (SSDI) benefit verification letter
      • Child Support/Alimony: You are not required to disclose income from alimony, child support, or separate maintenance payments unless you are using this as a basis for repayment of your loan.
      Additional documentation may be required.
    4. Official vendor quote for the assistive technology (AT) being purchased
      The quote should include the following:
      • A breakdown of costs
      • Vendor contact information
      • If you are purchasing an adapted vehicle, the quote must include: VIN, year, make, mileage, and type of accessible modifications.
    5. The entire and completed application.

    *IMPORTANT: If you have a Representative Payee and the Representative Payee is a family member, that person must be a co-applicant on the loan. By signing as a co-applicant, the rep-payee agrees that he/she is responsible for making the loan payments as he/she would make any payment on behalf of the beneficiary. If the applicant is no longer able to repay the loan the co-applicant would be responsible for paying the remainder of the loan balance.

    The application and supporting documents can be mailed, emailed, or faxed. The application itself can also be completed online by clicking the button below. If you have questions please contact PATF at 484-674-0506 or email patf@patf.us Fax: 484-674-0510 PATF's mailing address: 1004 West 9th Ave., King of Prussia, PA 19406

  • SECTION A - PRIVACY STATEMENT AND NOTICE

    Your privacy is important to us, and maintaining your trust and confidence is one of our highest priorities. We respect your right to keep your personal information confidential and understand your desire to avoid unwanted solicitations.

    We are happy to provide this privacy policy notice, and we hope you will take a few minutes to read it. You will have a better understanding of what we do with the information you provide us and how we strive to keep it private and secure.

    This notice explains how we collect, handle, and disclose personal information about you.

    Information We Collect

    We collect non-public personal information about you from the following sources:

    • Information we receive from you on applications and other forms;
    • Information about your transactions with us or others; and,
    • Information we receive from a consumer credit reporting agency (i.e., credit bureaus).

    Information We May Disclose

    We do not disclose non-public personal information about our applicants or borrowers or former applicants or borrowers to anyone, except to our partner banks, the credit bureaus and as required by law.

    Confidentiality and Security of Non-Public Personal Information

    Confidentiality and security of your non-public personal information is of paramount importance to us. We maintain physical, electronic, and procedural safeguards in compliance with all applicable laws and regulations to guard your non-public personal information from unauthorized access, alteration, and destruction. We restrict access to your non-public personal information to those employees and other parties who must use the information to provide services to you.

    • Telling Your Story

      We may use your “story” (for example, why you needed a loan, what equipment or technology you purchased, and how it impacted your life) to explain and market our program to other borrowers and contributors. However, we will not identify you by name unless you give us permission to do so. If you do not wish to have your story told, please indicate below. It will not affect your loan eligibility.

  • SECTION B - Loan Request

    Fields marked with a * are required.



Required information for PATF to process your application:

*Individual or Joint Credit
  • SECTION C - Applicant Information

    Fields marked with a * are required.

    *General Information
    • MM slash DD slash YYYY
    *Citizenship Information

    Previous Address
    • (if less than two years)
  • Employment History
    • (if less than two years)
    • (if less than two years)
  • *Nearest Relative
    • Section D – Co-Applicant Information (If Applicable)

    • This section is not required when applying for individual credit without a co-applicant
    • Section D – Co-Applicant Information (If Applicable)

      Fields marked with a * are required.

      *General Information
      • MM slash DD slash YYYY
      *Citizenship Information
      Previous Address
      • (if less than two years)
    • Employment History
      • (if less than two years)
      • (if less than two years)
    • *Nearest Relative

      Section E – Marital Status

      Fields marked with a * are required.

      Applicant
      • Alimony, Child Support, Separate Maintenance Payments: You are not required to disclose income from alimony, child support, or separate maintenance payments. However, if you are relying on income as a basis for repayment of this obligation, please complete the information below. Documentation verifying income will be required.

    • Alimony, Child Support, Separate Maintenance Payments: You are not required to disclose income from alimony, child support, or separate maintenance payments. However, if you are relying on income as a basis for repayment of this obligation, please complete the information below. Documentation verifying income will be required.

        Section F – Income & Expenses

        Fields marked with a * are required.

        Applicant's Income
        Applicant Assets (Optional)
        Monthly Expenses

        (Include installment loans, credit cards, rent, mortgages, etc.) Use separate sheet if necessary.

        Rent / Mortgage
        Credit Cards
        Automobile
        Auto Insurance
        Student Loan
        Other
      • Additional Information

          Section G – Assistive Technology and User

          Fields marked with a * are required.

          Individual with Disability
          • MM slash DD slash YYYY
          Disability/Assistive Technology Information
          • (Must be complete to process application.)
          • (Must be complete to process application.)
          • (YOU MUST attach quote with detailed information about the product, cost, and name of vendor/seller).

          Demographic information of the assistive technology user
          • We collect this background information to better understand the individuals we serve and to strengthen our ability to secure funding that supports our loan program. Providing this information is completely voluntary and will not impact your eligibility or access to services.

            However, your participation helps us demonstrate the need for AT funding, ensuring that we can continue to offer financial assistance to individuals with disabilities. Please complete this section with information about the person who will use the purchased assistive technology.

            Section H – Review and Sign

            Fields marked with a * are required.

            Review and Sign

            AUTHORIZATION

            I/We understand and agree that any information provided to or otherwise collected by PATF may be provided to one or more lenders (each, a “Lender”) in connection with my/our request for financing. I/We authorize PATF to share any and all information with any Lender, and also authorize such Lender to share any and all information regarding me/us, any loan application and any loan (including, without limitation, loan status) referred to such Lender by PATF with PATF and its representatives.

            I/We acknowledge and agree that each Lender, its agents, successors and assigns are third-party beneficiaries having the right to enforce the authorizations and certifications contained within this Application, and to exercise any rights and remedies to which they may be entitled at law or in equity.

            CREDIT REPORT AUTHORIZATION

            As part of your application for an extension of credit (“loan”) through Pennsylvania Assistive Technology Foundation (PATF), an approved PATF Lender requests your authorization to pull your credit report, including, but not limited to, your personal credit profile and other information on file at one or more consumer reporting agencies (“credit report”). You understand you are providing “written instructions” to the approved PATF Lender under the Fair Credit Reporting Act which authorizes the Lender to procure your credit report from one or more consumer reporting agencies. You authorize the Lender to verify information in your application and agree that the Lender may contact third parties to verify such information. The Lender may use your credit report(s) to authenticate your identity, to make credit decisions, and for related purposes.

            Applicant's Signature*
            • MM slash DD slash YYYY
          • Co-Applicant's Signature*
            • MM slash DD slash YYYY

            *IMPORTANT: If you have a Representative Payee and the Representative Payee is a family member, that person must be a co-applicant on the loan. By signing as a co-applicant, the rep-payee agrees that he/she is responsible for making the loan payments as he/she would make any payment on behalf of the beneficiary. If the applicant is no longer able to repay the loan the co-applicant would be responsible for paying the remainder of the loan balance.

            • Certification

            Section I – Certification

            Fields marked with a * are required.

            Certification

              I/We understand that this is a request for funds that I/We will need to repay. I/We authorize Pennsylvania Assistive Technology Foundation (PATF) to review all information provided and seek additional information from third parties required to verify the contents of this application. All information is true and correct and is provided to obtain the loan I/we am/are seeking. Any misrepresentation on any part of this application could result in rejection of this application or termination of the loan.

              I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001 et seq., and liability for monetary damages to PATF, any other lender, its agents, successors, assigns, insurers, and any other person who may suffer any loss due to reliance upon any misrepresentation I/we made in this application or in any other manner.

              I/We further understand that issuance of a loan does not imply any type of warranty by PATF or any other lender regarding the suitability, condition, merchantability or safety of the device or equipment that I/we purchase with the loan. I/We understand that I/we alone are responsible for selecting the devices or equipment to be financed. Therefore, I/WE CAN MAKE NO CLAIMS AGAINST PATF OR ANY LENDER OR ANY OF THEIR AGENTS, AND I/WE EACH HEREBY RELEASE PATF AND ANY OTHER LENDER, AND ALL OF THEIR RESPECTIVE AGENTS, FROM AND AGAINST ALL LIABILITY, FOR DEFECTS IN ANY DEVICE OR EQUIPMENT OR ANY ACCIDENT OR INJURY RESULTING FROM ITS USE.

              I/We hereby also authorize PATF and any lender to whom PATF may refer this application to disclose to PATF any information about any of us that the lender obtains or compiles that may be relevant to decisions PATF may make with respect to the application.

              Applicant's Signature*
              • MM slash DD slash YYYY
            • Co-Applicant's Signature*
              • MM slash DD slash YYYY
              • Important information about procedures for opening a new account

                Why are we asking for this information? 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.

            • {all_fields}

            Questions?

            We are happy to help answer your questions. Simply fill out the form below!

              Stay updated with Our Email Newsletter

              Newsletter Signup

              • Newsletter Signup

              1004 West 9th Avenue • King of Prussia, PA 19406

              Voice: 484-674-0506 Fax: 484-674-0510 patf@patf.us
              Contact Us
              CDFI logoMember of Opportunity Finance NetworkRAPC logo
              WCAG 2.1 AA seal

              Copyright 2025. Pennsylvania Assistive Technology Foundation. All Rights Reserved. Website Design by Inverse Paradox.

              • PATF Board Forum
              • Privacy Policy
              • Sitemap
              • Non Discrimination Policy
              • PATF Federal Compliance Statements and Language Assistance Plan
              • WCAG Conformance Claim
              Facebook Twitter Pinterest Instagram YouTube LinkedIn