Credit Card Application

Type of Credit
Check below to indicate the type of credit for which you are applying
Individual Credit Joint Credit Credit Limit Request Limit Increase Request
Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if: 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); your spouse will use the account, or 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 income you are relying.
Joint Credit: If you are applying with another person, complete the Applicant and Other sections.
If selected above, please indicate:
Credit Limit Requested	Limit Increase Requested
$	$
Special Instructions

Personal Information

Primary Applicant
First Name	Last Name	M.I.

Account #	Social Security #

Birthdate (mm/dd/yyyy)	Mother's Maiden Name/Password

Home Phone	Work Phone
() -Second partThird part	() -Second partThird part
Cell Phone	Email Address
() -Second partThird part
Primary Address

City	State	ZIP Code

Years at this address	Monthly Payment	Own or Rent?
	$	OwnRent
Complete for joint credit, secured credit or if you live in a community property state
MarriedSeparatedUnmarried (Single/Divorced/Widowed)

Joint Applicant
Type of Applicant
Co-ApplicantSpouse
First Name	Last Name	M.I.

Account #	Social Security #

Birthdate (mm/dd/yyyy)	Mother's Maiden Name/Password

Home Phone	Work Phone
() -Second partThird part	() -Second partThird part
Cell Phone	Email Address
() -Second partThird part
Present Address

City	State	ZIP Code

Years at this address	Monthly Payment	Own or Rent?
	$	OwnRent
Complete for joint credit, secured credit or if you live in a community property state
MarriedSeparatedUnmarried (Single/Divorced/Widowed)

Employment/Income

Primary Applicant
Employer

Employer's Address

City	State	ZIP Code

Gross Monthly Income	How long with this employer?
$
Notice: Alimony, child supposrt, or separate maintenance income need not be revealed if you do not choose to have it considered.
Other Income per Month	Source
$

Joint Applicant
Employer

Employer's Address

City	State	ZIP Code

Gross Monthly Income	How long with this employer?
$
Notice: Alimony, child supposrt, or separate maintenance income need not be revealed if you do not choose to have it considered.
Other Income per Month	Source
$

Other Information

Applicant
1) Are you a U.S. citizen?	YesNo
2) Are you a permanent resident alien?	YesNo
3) Do you currently have any outstanding judgements or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under Chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been party in a lawsuit?	YesNo
4) Are you a co-maker, co-signer or guarantor on any loan(s)? (If "YES", please complete Questions 4a through 4c.)	YesNo
4a) For whom? (Name of Others Obligated on Loan)
4b) To whom? (Name of Creditor)
4c) Obligation (Monthly Payment)	$

Joint Applicant
1) Are you a U.S. citizen?	YesNo
2) Are you a permanent resident alien?	YesNo
3) Do you currently have any outstanding judgements or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under Chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been party in a lawsuit?	YesNo
4) Are you a co-maker, co-signer or guarantor on any loan(s)? (If "YES", please complete Questions 4a through 4c.)	YesNo
4a) For whom? (Name of Others Obligated on Loan)
4b) To whom? (Name of Creditor)
4c) Obligation (Monthly Payment)	$

Personal Reference
Name of Nearest Relative not Living with You	Relationship

Address

Home Phone	Work Phone
() -Second partThird part	() -Second partThird part

User Agreements
Account Disclosures
Primary Applicant: You promise that everything that you have stated in this application is correct to 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 of 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. Other Applicant: 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 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.
I accept the terms of the User Agreements

Click here to view the Account Disclosures.
I have read, understand and agree to the terms of application.

E-Sign Act Disclosure
Click here to view the E-Sign disclosure.
I have read, understand and agree to the E-Sign Act.

Primary Signature

Joint Signature

Date (mm/dd/yyyy)

Please enter the security code below prior to submitting the form

Security code