Loan Application * Required Fields Membership: I am a Select...MemberPotential Member If you are a potential member of the credit union, how do you qualify for membership? Select...Polish American CongressSt. Andrew Parish Community Credit UnionPolish Scouting Organization2nd Polish Corps at Orchard Lake SchoolsAmerican Polish Cultural CenterAmerican Polish Engineering AssociationPope John Paul II Society, P.R.C.U.A.St. Ladislaus Credit UnionCity of Hamtramck EmployeeHamtramck Public Schools EmployeeAll Star Amusement EmployeeOur Lady of CzestochowaAmerican-Polish Century ClubWhite Eagle Sports ClubNational Polish-American Sports Hall of FamePolish Century Club of Detroit, Inc. * Purpose/Type of Loan: Select...New AutoUsed AutoVISA Credit CardRecreational VehicleShare SecuredOther If Other, what is the purpose? * Loan Amount * Requested Term Select...12 Months24 Months36 Months48 Months60 Months72 Months Click here for Loan Calculator If applying for an auto loan - please include: Year Make Model Mileage VIN Interested in an Auto Loan? Just looking now * Full Name * Soc. Sec. Number Address City State Select State...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Date of Birth Date of Birth Monthmonth...JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / Date of Birth Dayday...12345678910111213141516171819202122232425262728293031 / Date of Birth Yearyear...190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049 E-mail Address Phone ( Phone 1 ) Phone 2 - Phone 3 ext Phone Extension Daytime Phone ( Daytime Phone 1 ) Daytime Phone 2 - Daytime Phone 3 ext Daytime Phone Extension Mother's Maiden Name * Employer Address City State Select State...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Employer Phone ( * Employer Phone 1 ) * Employer Phone 2 - * Employer Phone 3 ext * Employer Phone Extension Position/Occupation * Date Hired * Date Hired Monthmonth...JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / * Date Hired Dayday...12345678910111213141516171819202122232425262728293031 / * Date Hired Yearyear...190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049 Gross Monthly Income Notice: Alimony, child support or separate maintenance income need not be revealed if you do not choose to have it considered. Other Source of Income Alimony Child Support Second job Rental Other If Other, please explain Monthly Amount Do you Own w/mortgage Own w/o mortgage Rent Live w/relatives Other If Other, please explain Monthly Payment Previous Employment (If less than 2 years with current employer.) Employer Position/Occupation Date Hired Date Hired Monthmonth...JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / Date Hired Dayday...12345678910111213141516171819202122232425262728293031 / Date Hired Yearyear...190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049 Date Left Date Left Monthmonth...JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / Date Left Dayday...12345678910111213141516171819202122232425262728293031 / Date Left Yearyear...190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049 References - Please include Street, City, State and Zip Name of Nearest Relative Not Living With You Address City State Select State...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Relationship to Applicant Phone ( Phone 1 ) Phone 2 - Phone 3 ext Phone Extension Please fill out this section if there is a Co-Borrower. Name Soc. Sec. Number Address City State Select State...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Date of Birth Date of Birth Monthmonth...JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / Date of Birth Dayday...12345678910111213141516171819202122232425262728293031 / Date of Birth Yearyear...190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049 Phone ( Phone 1 ) Phone 2 - Phone 3 ext Phone Extension Relationship Employer Address City State Select State...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Position/Occupation Date Hired Date Hired Monthmonth...JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / Date Hired Dayday...12345678910111213141516171819202122232425262728293031 / Date Hired Yearyear...190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049 Gross Monthly Income Employer Phone ( Employer Phone 1 ) Employer Phone 2 - Employer Phone 3 ext Employer Phone Extension Notice: Alimony, child support or separate maintenance income need not be revealed if you do not choose to have it considered. Other Source of Income Alimony Child Support Second job Rental Other If Other, please explain Amount Do you Own w/mortgage Own w/o mortgage Rent Live w/relatives Other If Other, please explain Monthly Payment Name of Nearest Relative Not Living With You Address City State Select State...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Relationship to Applicant Phone ( Phone 1 ) Phone 2 - Phone 3 ext Phone Extension Additional Comments I certify that the information that I provide in this credit application is for the purpose of obtaining credit and the statements made herein are true and accurate. I hereby authorize Polish-American Federal Credit Union to check my credit and employment history. I hereby acknowledge that Polish-American Federal Credit Union may report information about my account to credit bureaus. Late payments, missed payments, or other defaults on my account may be reflected in this credit report. If this application is for a purchase, I authorize Polish-American Federal Credit Union to pay the proceeds of the loan directly to the seller. * I Accept I Decline Security Code What's This?