VISA® Credit Card Application

Line of Credit Type



General Applicant Information

years

Previous Home Address

years
$
$
years

years

General Co-Applicant Information

years

Previous Home Address

years
$
$
years

years

Other Income Information - Applicant

Alimony, child support, or separate income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Court Order
Written Agreement
Oral Understanding

$ per
Yes     No

Other Income Information - Co-Applicant

Alimony, child support, or separate income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Court Order
Written Agreement
Oral Understanding

$ per
Yes     No

Outstanding Debts

(include charge accounts, installment contracts, credit cards, rent, mortgages, etc.)
Home
$
$
$
$
Auto Loan
$
$
$
Debt 1
$
$
$
Debt 2
$
$
$
Debt 3
$
$
$
Debt 4
$
$
$

Bank Balance

$

Additional Information


Yes     No
Yes     No
$
Yes     No
Married
Separated
Unmarried

This statement is submitted to obtain credit and I (we) certify that all information herein is true and complete. I (We) also authorize the Credit Union to verify or obtain further information the Credit Union may deem necessary concerning my (our) credit standing. If this application is approved and Line of Credit is issued, the applicant(s) by pressing the "Submit this Application" button below, agree(s) that the applicant(s) will be bound by the terms and conditions accompanying the Line of Credit and all amendments. In addition, I/we are providing express consent to be contacted as needed by autodialers from the credit union card fraud departments.