VISA Credit Card Application

 
  We intend to apply for joint credit
Individual Joint Account
Individual with authorized user  
Last name, first name, middle initial: Last name, first name middle initial:
APPLICANT

VISA Classic   VISA Platinum

Limit requested:

Email:

Social security number:

Date of birth:

Number of dependents:

Home phone number:

Present home address (no. street, city, state, zip code):

Own Rent With parents
How long: years/months

Previous home address (no. street, city, state, zip code):

Drivers license number:

Present employer (name & address):

How long:

Business phone number:

Position:

Department:

Gross salary:

Previous employer
(if employed by above less than two years):

How long?

Source of other income if any. Include overtime, part time job, rental income, (you do not have to disclose alimony, child support, separate maintenance income or its source unless you want us to consider it in connection with this application) if indicated, verification may be requested.
Amount:
CREDIT REFERENCES

Include all loans, department store cards, bank cards, and debts now owing or recently paid.
(1) Creditor:

Account no.

Balance:

Monthly payment:

(2) Creditor:

Account no.

Balance:

Monthly payment:

(3)
Creditor:

Account no.

Balance:

Monthly payment:

(4)
Creditor:

Account no.

Balance:

Monthly payment:

(5)
Creditor:

Account no.

Balance:

Monthly payment:

Name of relative not living with you:

Address:

Relationship:

Phone number:

Name of 2nd relative not living with you:

Address:

Relationship:

Phone number:

Mortgage holder (or landlord) name and address:
First:

Monthly rent or board:

Mortgage balance:

Mortgage payment:

Second:

Mortgage balance:

Mortgage payment:

Date purchased:

Purchase price:

Current market value:

Home in whose name:

Year and make of automobile:

Financed by:

Balance owed:

Monthly payment:

(2) Year and make of automobile:

Financed by:

Balance owed:

Monthly payment:

Have you ever filed bankruptcy:
Yes    No 
Are you a co-maker on any loan:
Yes    No 
Monthly payment:

Balance:

Are you liable for any child support, or
maintenance payments:
Yes    No 
Per month:

CO-MAKER / CO-APPLICANT
Social security number:

Date of birth:

Home phone number:

Present home address (no. street, city, state, zip code):

Own Rent With parents
How long: years/months

Previous home address (no. street, city, state, zip code):

Mortgage Holder or landlord name and address

Monthly rent or board

Monthly Mortgage:

Mortgage Balance:

Drivers license number:

Present employer (name & address):

How long:

Relationship to applicant:

Co-makers present employer (name & address):

Business phone number:

Position:

Department:

Gross salary:
CREDIT REFERENCES

Include all loans, department store cards,
bank cards, and debts now owing or recently paid.
(1) Creditor:

Account no.

Balance:

Monthly payment:

(2) Creditor:

Account no.

Balance:

Monthly payment:

(3)
Creditor:

Account no.

Balance:

Monthly payment:

(4)
Creditor:

Account no.

Balance:

Monthly payment:

(5)
Creditor:

Account no.

Balance:

Monthly payment:

Name of relative not living with you:

Address:

Relationship:

Phone number:

Name of 2nd relative not living with you:

Address:

Relationship:

Phone number:

Mortgage holder (or landlord) name and address:
First:

Monthly rent or board:

Mortgage balance:

Mortgage payment:

Second:

Mortgage balance:

Mortgage payment:

Date purchased:

Purchase price:

Current market value:

Home in whose name:

Year and make of automobile:

Financed by:

Balance owed:

Monthly payment:

(2) Year and make of automobile:

Financed by:

Balance owed:

Monthly payment:

Have you ever filed bankruptcy:
Yes    No 
Are you a co-maker on any loan:
Yes    No 
Monthly payment:

Balance:

Are you liable for any child support, or
maintenance payments:
Yes    No 
Per month:

You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension, or collection of the credit received. You authorize the Credit Union to verify or have reverification of any information contained in the application at any time. You understand that the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on the loan applications made to federal credit unions or state chartered credit unions insured by NCUA. You understand that the use of your card will constitute acknowledgement of receipt and agreement to the terms of the credit card agreement. A condition of your account is granting us a security interest in your share accounts. By signing below you grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure your credit card account. Shares and deposits in any Individual Retirement Account and any other account that would lose special tax treatment under state or federal law if given as security are not subject to this security interest. When you are in default we may apply the balance in these accounts to any amounts due under the credit card agreement.

I Disagree