Visa Credit Card Application

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"*" indicates required fields

Applicant

Member/Account #*

Member's Full Name*

Marital Status*

Married

Unmarried

Separated

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

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

Application Not Valid Without Proper Signature(s)

I authorize POLAM FCU to check my credit and employment history, to make inquiries (including requesting reports from consumer credit reporting agencies and other sources) to verify my identity and determine my eligibility for credit, and in connection with any extension of credit, update, renewal, review or collection of my account or for any other legal purpose. On my request, you (POLAM FCU) will tell me whether or not you requested a credit report and the names and addresses of any credit bureaus that provided you such reports. I authorize POLAM FCU to release information to others about my credit history with POLAM FCU. I understand that you may report information about my account to credit bureaus. Late payments, missed payments, or other defaults on my account may be reflected in my credit report regardless of who made a transaction. For CA Residents: Regardless of your marital status, you may apply for credit in your name alone. If this is a joint account, after credit approval each applicant has the right to use this account to the extent of any credit limit set by the creditor, and each applicant may be liable for all amounts of credit extended under this account to any joint applicant. Everything that I have stated in this application is correct to the best of my knowledge. This application will remain your property and you will retain it whether or not this application is approved. I PROMISE TO REPAY POLAM FEDERAL CREDIT UNION ALL SUMES ADVANCED ON MY VISA CREDIT CARD ACCORDING TO THE TERMS AND CONDITIONS IN THE CREDIT CARD DISCLOSURE AND AGREEMENT. MY USE OF THIS CARD WILL CERTIFY MY AGREEMENT TO THOSE TERMS. I AGREE TO CHANGES IN THE TERMS AND CONDITIONS IF I CONTINUE TO USE THE ACCOUNT 15 DAYS AFTER YOU GIVE NOTICE OF CHANGE.

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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Phone

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