Consumer Loan Application

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Comments

This field is for validation purposes and should be left unchanged.

Purpose*

Amount*

Collateral Description*

Member/Account #*

Applicant

Member's Full Name*

Marital Status*

Married

Unmarried

Single

Date of Birth*

Social Security No.*

Current Address*

Street Address Address Line 2 City State ZIP Code

How Many Years Resident*

Home Phone*

Mother's Maiden Name*

Email Address*

Driver's License No.*

Cell Phone*

Current Employer*

Business Address*

Street Address Address Line 2 City State ZIP Code

Business Phone*

Job Title*

Type of Business*

Gross Monthly Salary*

Length of Time Employed*

Work Email Address*

Previous Employer

(If less than one year)

Previous Business Address

Street Address Address Line 2 City State ZIP Code

Own or Rent Home*

Own

Rent

Monthly Payment*

Name of Nearest Relative*

(Not living with you)

Relative's Address*

Street Address Address Line 2 City State ZIP Code

Relative's Phone*

Name of Nearest Relative*

(Not living with you)

Relative's Address*

Street Address Address Line 2 City State ZIP Code

Relative's Phone*

Co-Applicant

Choose One

Co-Borrower

Spouse

Co-Borrower

Spouse

Member's Full Name

Home Phone

Cell Phone

Date of Birth

Social Security No.

Current Address

Street Address Address Line 2 City State ZIP Code

Monthly Rent

Drivers License No.

Email Address

Current Employer

Business Address

Street Address Address Line 2 City State ZIP Code

Occupation & Length

Monthly Income

Business Phone

Name of Nearest Relative

(Not living with you)

Relative's Address

Street Address Address Line 2 City State ZIP Code

Relative's Phone

Signature(s) “I”, “me” and “my” hereafter includes all applicants signing below. “You”, “your” and “yours” mean POLAM Federal Credit Union. I certify that I am eighteen years or older and that the information contained in this application is current and accurate. I will notify you in writing immediatelyif there is any change in my financial condition. I understand that it is aviolation of Section 1014, Title 18 U.S. Code to make a false statement for the purpose of influencing the action of a federally insured credit union. The applicable credit union Loan Agreement is not binding upon me or you until my loan is approved. By using or authorizing others to use my account, I will be bound by the terms and conditions of the applicable Loan Agreement. If I wish optional Credit Life and/or Credit Disability Insurance on an eligible loan, then I must complete, sign and return to you a “CreditLife Insurance and Credit Disability Insurance Cost Disclosure and Authorization” form. Under California law, or other applicable state law, my address in Department of Motor Vehicles (DMV) records may be confidential. I authorize you and/or your affiliates to obtain such address and other information therein from the DMV as permitted by law. I authorize you to 1) gather any credit or employment information you deem necessaryand appropriate, from time to time, 2) retain this application whether or not credit is granted and 3) give information concerning your credit experience with me to others as appropriate, from time to time. You agree to tell me if I ask whether a credit report has been requested by you. If you receive a credit report, you agree to give me the name and address of the credit reporting agency that furnished it. My application for an unsecured loan account may, if approved, include a PLOC and/or VISA Card and I request the same. For a VISA Account, I request a card in my name. If I wish to designate an authorized user(s), I shall contact the credit union for an additional card(s). The credit union may, as my agent and attorney in fact, disburse loan proceeds to my credit union account(s) or to third parties. All loans subject to credit approval.

Application Not Valid Without Proper Signature(s)

Signature*

Date*

Signature of Co-Applicant

Date

Please Include Proof of Income (Pay-Stub or Tax Return) With Your Application

File

Max. file size: 8 MB.

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