HALO Club Request Form

The HALO Club offers financial assistance to all current employees of Mutual of Omaha and Mutual of Omaha Bank, regardless of geographic location.

Please note that the HALO Club does not provide assistance through the payment of deposits of any kind, including rental or utility deposits.

A request form is required for consideration. All fields are required – incomplete forms may be rejected.

Personal Information

(xxx-xxx-xxxx)

Is your address permanent or temporary?

Is your situation a result of a disaster?

Please use the space below to explain your situation in detail.

How much are you seeking from HALO Club?

$

Please check all that apply to your current situation.

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