Authorized User Credit Card Application

Required Field

Cardholder Information

First Name Middle Name Last Name Suffix Last 4 Digits of Credit Card Number Social Security Number Birth Date Current Address City State Zip Code Mailing address is different than street address

Mailing Address City State Zip Code

Mobile Phone Number Home Phone Number E-mail Address

Authorized User Information

Please note: If you name your legal spouse as an authorized user, in accordance with federal law, UCB will report the credit history of the credit card account in your spouse's name as well as in yours.

First Name Last Name Is this person your legal spouse? Social Security Number

(Click the + sign to add additional card holders)

 Add Another User

Acknowledgements and Agreements

I hereby apply for a Visa Credit Card(s) to be issued to the above listed authorized users for use in conjunction with the above listed account. I agree that use of the Visa Credit Card will be subject to the terms and conditions contained in my Credit Card Agreement that was provided to me at the opening of my account.

By clicking submit below, I acknowledge that I have read the Electronic Record and Signature Disclosure. I also agree that the Internet access device(s) I will use to receive the related legal disclosures and agreements meet(s) the system requirements described in the disclosure presented below; and I consent to receiving the related legal disclosures and agreements.

I have read and agree to the Electronic Record and Signature Disclosure.

Click Here to view the Electronic Record and Signature Disclosure.