Credit Card Application

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Please read and complete the application below.

Bold fields are required.

Individual Credit
Complete Applicant sections if only the
applicant's income is considered for loan
approval.

Joint Credit
Complete Applicant and Co-Applicant sections if your co-applicant will be contractually liable for repayment of the loan.

Account Number

Amount Requested $
    Visa Platinum
    Visa Platinum Rewards

Deduct Application Fee from:
Savings Checking

Number of Cards:

Applicant

Co-Applicant

Name
Email
Home Phone
Cell Phone
Birth Date
Social Security #
No. of Dependents
Present Address	Own Rent
Street
City
State
Zip Code
Monthly Payment
Lived Here For
Previous Address (if less than 2 years)
Street
City
State
Zip Code

Name
Email
Home Phone
Cell Phone
Birth Date
Social Security #
No. of Dependents
Present Address	Own Rent
Same Address for Co-Applicant
Street
City
State
Zip Code
Monthly Payment
Lived Here For
Previous Address (if less than 2 years)
Street
City
State
Zip Code

Employment / Income

Present Employer
Street Address
City
State
Zip Code
Position
Work Phone
Monthly Gross Income
Years There
Monthly Other Income
Source
Previous Employer (if less than 2 years)
Street Address
City
State
Zip Code
Phone

Present Employer
Street Address
City
State
Zip Code
Position
Work Phone
Monthly Gross Income
Years There
Monthly Other Income
Source
Previous Employer (if less than 2 years)
Street Address
City
State
Zip Code
Phone

References

Name
Phone
Street Address
City
State
Zip Code

Name
Phone
Street Address
City
State
Zip Code

Applicant Debt Information

Institution	Balance Owed	Monthly Payment

PLEASE READ BEFORE SUBMITTING:

All the information in this application is true. I understand that section 1014 Title 18 U.S. Code makes it a federal crime to knowingly make a false statement on this application. You have my permission to check it. You may retain this application even if not approved. I understand that you may receive information from others about my credit and you may answer questions and requests from others seeking credit or experience information about me or my accounts with you. If this application is approved, I agree to honor the provisions of the credit or loan agreement and security agreement covering my account or loan. (If this application is for two of us, this statement applies to both of us.)

CREDIT REPORT AUTHORIZATION:
By submitting this Application, I authorize you to obtain my credit report for the purposes of evaluating this application and to obtain subsequent credit reports on an on-going basis in connection with this transaction, and for all other legitimate purposes, such as reviewing my accounts or taking collection action on the account.

IMPORTANT NOTICE ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT:
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for me: When I open an account, you will ask for my name, address, date of birth, and other information that will allow you to identify me. You may also ask to see my driver's license or other identifying information.

VISA Application