Utah Assistive Technology
Foundation
Introduction
The nonprofit Utah Assistive Technology Foundation (UATF) and Zions Bank help make independence affordable by offering low interest financial loans to purchase assistive technology devices, including home modifications and adapted vehicles. Loans are unsecured, except for adapted vehicles. Our goal is to assist Utahns with disabilities by enhancing their independence, education, employment, and quality of life through assistive technology.
There are two types of loans which
can be applied for: Assistive Devices
and Telework. If you are interested in applying
for an assistive device such as a wheelchair or adaptive van, please
print and fill out the five parts of the Assistive Device Loan Program.
If you are interested in obtaining a loan for a work-related device
such as a computer or cell phone, please print and fill out the five
parts of the Telework Loan Program.
Complete all forms completely in black ink and return with an invoice indicating model/serial number, and total price, to:
Utah Assistive Technology Foundation
6835 Old Main Hill
Logan, UT 84322
If you prefer, you can fax completed forms to: (435) 797-2355
Please ensure all forms are filled out completely to assist in timely processing.
- Send an invoice or statement with total price for the assistive device you want to purchase.
- Completed application forms will first be reviewed by the UATF. If the applicant is eligible, the forms will be forwarded to Zions Bank.
- If the loan is approved, the check will be made payable to the applicant and the provider(s)/ vendor(s).
If you have any questions, please contact us at (800) 524-5152.
If you do not have Acrobat to view the forms in
pdf format, visit the Adobe
Acrobat site to download the newest reader.
Assistive
Device Loan Program
Part One:
Information Disclosure Letter
The applicant’s signature on this letter allows the UATF to
discuss your information with Zions Bank. Your signature is all that
is required on this form.
Part Two:
Device Information
This form provides UATF with information about the vendor and equipment.
You will need to send an invoice from each vendor with the exact price
(including any tax, shipping and handling).
Part
Three: Eligibility
The UATF uses this form to determine eligibility for a loan. Please
ensure you complete all blanks and sign the form. Income verification is required by Zions Bank. Please include last two bank statements showing all income, or last two months pay stubs, or last two years tax returns (front page only).
Part
Four: Consumer Loan Application
Zions Bank uses this form to determine loan approval. Complete and
accurate information and your signature are required on this form.
Part
Five: Release of Information for Data Collection
Please mark the box which gives your consent to release required information to the federal sponsors of this program. Information will remain confidential.
• Send a copy of
an invoice or other paperwork showing the total price for the assistive
device you want to purchase.
• Completed application forms will first be reviewed by the
UATF. If the applicant is eligible, the forms will be forwarded to
Zions Bank for loan approval. Zions Bank will make the final loan
decision.
• If the loan is approved, the check will be made payable to both
the applicant/borrower and the provider(s)/vendor(s).
Telework Loan Program
Part
One: Information Disclosure Letter
The applicant’s signature on this letter allows the UATF to
discuss your information with Zions Bank. Your signature is all that
is required on this form.
Part Two:
Device Information
This form provides UATF with information about the vendor and equipment.
You will need to send an invoice from each vendor with the exact price
(including any tax, shipping and handling).
Part
Three: Eligibility
The UATF uses this form to determine eligibility for a loan. Please
ensure you complete all blanks and sign the form. Income verification is required by Zions Bank. Please include last two bank statements showing all income, or last two months pay stubs, or last two years tax returns (front page only).
Part
Four: Consumer Loan Application
Zions Bank uses this form to determine loan approval. Complete and
accurate information and your signature are required on this form.
Part
Five: Release of Information for Data Collection
Please mark the box which gives your consent to release required information to the federal sponsors of this program. Information will remain confidential.
• Send a copy of
an invoice or other paperwork showing the total price for the assistive
device you want to purchase.
• Completed application forms will first be reviewed by the
UATF. If the applicant is eligible, the forms will be forwarded to
Zions Bank for loan approval. Zions Bank will make the final loan
decision.
• If the loan is approved, the check will be made payable to both
the applicant/borrower and the provider(s)/vendor(s).
If you have any questions, please contact us at (800) 524-5152.
