| Credit
Card Application |
| Check
below to indicate the type of account(s) and type of credit for which you
are applying. Married applications may apply for a separate account |
|
Individual
Credit: You must complete the Applicant section about yourself
and the Other section about your spouse if: |
| 1. |
you
live in or the property pledged as collateral is located in a community
property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI), |
| 2. |
your
spouse will use the account, or |
| 3. |
you
are relying on your spouse's income as a basis for repayment. If you
are relying on income from alimony, child support, or separate maintenance,
complete the Other section to the extent possible about the
person on whose payments you are relying. |
|
Joint
Credit: If you are applying with another person, complete the
Applicant and Other sections. |
|
| NAME
(last - first - Initial) |
MOTHER'S
MAIDEN NAME |
| DRIVER'S
LICENSE NUMBER / STATE |
| ACCOUNT
NUMBER |
SOCIAL
SECURITY NUMBER |
| BIRTH DATE |
HOME PHONE |
BUSINESS
PHONE / EXT. |
| |
( ) |
( ) |
|
| PRESENT
ADDRESS (Street - City - State - Zip) |
|
OWN
|
|
RENT
|
| |
|
|
| MORTGAGE/RENT
OWED TO: |
MORTGAGE
BALANCE
$ |
MONTHLY
PAYMENT
$ |
INTEREST
RATE
% |
| COMPLETE
FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY
PROPERTY STATE: |
| |
MARRIED |
|
SEPARATED
|
|
UNMARRIED
|
(Single
- Divorced - Widowed) |
|
| EMPLOYMENT/INCOME |
NAME AND
ADDRESS OF
EMPLOYER |
|
| START DATE |
POSITION |
| NOTICE: : |
ALIMONY
CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED
IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED |
|
| EMPLOYMENT
INCOME |
OTHER
INCOME |
| $_______________ |
PER_______________ |
$_______________ |
PER_______________ |
| |
|
SOURCE______________________________ |
|
| GUARANTOR |
|
RELATIONSHIP |
NAME
AND ADDRESS
OF NEAREST
RELATIVE NOT
LIVING WITH YOU |
|
HOME
PHONE |
|
|
| Other:
|
|
Co-Applicant |
|
Spouse |
|
|
| NAME
(last - first - Initial) |
MOTHER'S
MAIDEN NAME |
| DRIVER'S
LICENSE NUMBER / STATE |
| ACCOUNT
NUMBER |
SOCIAL
SECURITY NUMBER |
| BIRTH DATE |
HOME PHONE |
BUSINESS
PHONE / EXT. |
| |
( ) |
( ) |
|
| PRESENT
ADDRESS (Street - City - State - Zip) |
|
OWN
|
|
RENT
|
| |
|
|
| MORTGAGE/RENT
OWED TO: |
MORTGAGE
BALANCE
$ |
MONTHLY
PAYMENT
$ |
INTEREST
RATE
% |
| COMPLETE
FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY
PROPERTY STATE: |
| |
MARRIED |
|
SEPARATED
|
|
UNMARRIED
|
(Single
- Divorced - Widowed) |
|
| EMPLOYMENT/INCOME |
NAME AND
ADDRESS OF
EMPLOYER |
|
| START DATE |
POSITION |
| NOTICE: : |
ALIMONY
CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED
IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED |
|
| EMPLOYMENT
INCOME |
OTHER
INCOME |
| $_______________ |
PER_______________ |
$_______________ |
PER_______________ |
| |
|
SOURCE______________________________ |
|
| GUARANTOR |
|
RELATIONSHIP |
NAME
AND ADDRESS
OF NEAREST
RELATIVE NOT
LIVING WITH YOU |
|
HOME
PHONE |
|
|
|
OHIO RESIDENTS
ONLY: The Ohio laws against discrimination require that all creditors
make credit equally available to all creditworthy customers, and that
credit reporting agencies maintain separate credit histories on each individual
upon request. The Ohio Civil Rights Commission administers compliance
with this law.
WISCONSIN RESIDENTS ONLY:(1) No provision of any marital property
agreement, unilateral statement under Section 766.59, or court decree
under Section 766.70 will adversely affect the rights of the Credit Union
unless the Credit Union is furnished a copy of the agreement, statement
or decree, or has actual knowledge of its terms, before the credit is
granted or the account is opened. (2) Please sign if you are not applying
for this account or loan with your spouse. The credit being applied for,
if granted, will be incurred in the interest of the marriage or family
of the undersigned.
X_______________________________________________________________________________
SIGNATURE FOR WISCONSIN RESIDENTS ONLY Date
|
| You
promise that everything you have stated in this application is correct 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
understand that the Credit Union will rely on the information in this application
and your credit report to make its decision. If you request, 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 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 your granting us a security interest in your share accounts.
By signing below you grant 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 an 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.
|
| X |
__________________________________________ |
X |
__________________________________________ |
|
Applicants
Signature Date |
|
Other
Signature Date |
|
| |
VISA
CLASSIC |
| Annual
Percentage Rate |
9.9%
- 17.9% |
| Annual
Membership Fee |
$0
- 49$ |
| Grace
Period for Purchases |
25
DAYS |
| Method
of Computing Balance |
Average
Daily Balance (including new purchases) |
| Minimum
Finance Charge |
NONE |
| Transaction
Fee |
NONE |
Cash
Advance Fee: 1% of transaction amount
Over-Credit-Limit Fee: $20.00 or 2%
Late Payment Fee: $28.00 if paid after next statement drop
date. Late payments and over-limit transactions violate your VISA
account agreement
Return Check Fee: $28.00 |
|
| For
Credit Union Use Only |
| DATE |
|
APPROVED |
# OFCARDS
____ CREDIT LIMITS______ CREDIT
CARD NUMBER____________________ |
| |
|
DENIED
(Adverse Action Notice Sent) |
CREDIT
COMMITTEE OR LOAN OFFER SIGNATURE ____________________________________ |
|
|
You
Must Print, Sign, and Return to Credit Union
|
