VISA Application
Credit Limit Requested: $_______________ Number of Cards________

All requests will be handled promptly and in a confidential manner.
Important instructions: Complete and sign "Applicant" portion to apply for credit in your name only.To apply for a joint account, you complete and sign the "Applicant" portion, and the joint applicant completes and signs the "Co-applicant" portion. Both applicant and co-applicant must belong to the Credit Union, and both assume responsibility for any charges made to the account Availability of an individual account with an authorized user depends on the board policy.
Applicant Information

Last Name____________________ First Name_____________ Date of Birth___________

Mothers Maiden Name__________________ Social Security Number___________________

Current Address______________________________ City______________ State___ Zip
Previous Address_____________________ Length of Residence_______
Tell Us About Your Employment
Present Employer____________________ Position______________ Employer Phone______
Gross Monthly Income_________ Length of Employment______ Other Income and Source
Former Employer_______________ Length of Employment_______ Position____________
Your Credit References

Mortgage (rent) Payment________ Mortgage Balance__________ Approx. Market Value

Checking Account with:______________________________ Balance________________

Savings Account With:_______________________________ Balance________________

Co-Applicant Information

Name and Relationship_________________ Soc.Sec. Number___________ Date of Birth___________

Address_____________________________________ Mothers Maiden Name________________

Length of Residence________ Rent/Own Monthly Payment_________________

Employer_______________________ Length of Employment_______ Employer Phone______

Gross Monthly Income_____________ Current Position______________________________

Former Employer_____________ Length of Employment_______ Other Income and Source

*Alimony or child support of maintenance payments are optional information and need not be
revealed if the applicant does not choose to rely on such income in applying for credit.

This statement is submitted to obtain credit and I (we) Certify that all information herein is true andcomplete. I (We) also authorize the Credit Union to verify or obtain further information the CreditUnion may deem necessary concerning my (our) credit standing. If this application is approved and aCredit Card(s) issued, the undersigned applicant(s) by signing, using, or permitting another to use the Credit Card(s) agree(s) that the applicant(s) will be bound by the terms and conditions accompanying the Credit Card(s) and all amendments. I (We) hereby acknowledge that I/we will receive a copy of the Credit Union Credit Card Agreement and Disclosure end Billing Rights that inform me (us) of the terms, responsibilities and rights as a Credit Union Credit Card account user.

I/We acknowledge that I/we will receive a copy of the disclosure Statement informing me/us of my/our rights under the Electronic Funds Transfer Act and Truth-In-Savings Act, as applicable.

X____________________________________________ Date__________________________
Applicant's Signature
X____________________________________________ Date__________________________

Co-Applicant's Signature
(All persons requesting a card must sign and will be contractually liable.)