Credit Card Application Click here for Credit Card Disclosure Requested Limit: First Name: Middle Initial: Last Name: Account Number: Social Security Number: Date of Birth (MM/DD/YYYY): Home Phone: Cell Phone: Allow Text Messages: Yes No Email: Address: Address: Address Second Line City: State: Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP: Home Status: Own Rent Other Monthly Rent/Mortgage: Employer Business: Occupation: Employer Phone: Length of Employment: Monthly Take Home Pay: Co-Applicant First Name: Middle Initial: Last Name: Social Security Number: Date of Birth (MM/DD/YYYY): Phone: Address: Address: Address Second Line City: State: Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP: Employer Business: Occupation: Employer Phone: Length of Employment: Monthly Take Home Pay: Comments: I/we certify that the above information is true. I/we authorize investigation and verification of my/our credit, employment and income references determine my/our eligibility for the credit card and renewal or future extension of credit. If an account is opened, I/we authorize you to report your credit experience with me/us. The undersigned jointly and severally agree to be responsible for all charges, cash advances, and other fee and terms and conditions on the VISA account, which will be mailed to me upon approval. I/we further pledge all credit union shares and deposit where the credit union may enforce a lien by taking a setoff against all such present and future shares in my/our name to the extent of that portion of the loan balance which may be in default, whether by acceleration or otherwise. I/we understand and agree that if my/our loans become delinquent or past due, my/our VISA credit card may be revoked or my/our credit line reduced. I/we understand that the credit limit may be increased or the terms of payment extended or modified, from time to time whether or not upon my/our express request without notice to me/us or any other signer, and that I/we shall nonetheless be responsible for the repayment of all charges incurred upon this account. This includes charges or extensions of credit, unless we specifically request otherwise in writing. The credit union will retain this application whether or not it is approved. Agreement: I/We Agree to Terms Requested Limit: Security Code: Security Code
