Personal Visa Credit Application

* Required Field

Information

I/We intend to apply:
Individually Jointly 		Amount Requested *

Federal Law requires financial instituitions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide is protected by our privacy policy.

Applicant
First Name *
 MI
Last Name *
Social Security Number *
 Driver's License Number
Street Address *
 City *
State *
 Zip Code *
Home Phone
Cell Phone
Work Phone
Ext
Do you:
Own Rent 		Birthdate (Month/Day/Year)
E-mail Address

Employment Information
Employer *
 Telephone Number
 Supervisor
Street Address
 City
State
 Zip Code
Position/Department
 Length of Employment
 years  months
Income *
 Per *
Other Sources of Income
 Amount Per Month

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


Completion Instructions for Co-Applicants

(a) If you are applying for joint credit or will be permitted to use the account, complete the Co-Applicant section as Borrower. (b) If the Applicant is applying for individual credit, but relying on income from alimony, child support, or separate maintenance or the income or assets of another person as the basis for repayment of the credit requested, complete the Co-Applicant section, to the extent possible, providing information about the person on whose alimony, support or maintenance payments or income or assets the Applicant is relying. (c) If the Applicant resides in a community property state or is relying on property located in such a state as a basis for repayment of the credit requested, complete the Co-Applicant section with regard to the Applicant's spouse.

Co-Applicant
First Name
MI
Last Name
Social Security Number
Driver's License Number
Street Address
City
State
Zip Code
Home Phone
Cell Phone
Work Phone
Ext
Do you:
Own Rent 		Birthdate (Month/Day/Year)
E-mail Address

Employment Information
Employer
 Telephone Number
 Supervisor
Street Address
 City
State
 Zip Code
Position/Department
 Length of Employment
 years  months
Income
 Per
Other Sources of Income
 Amount Per Month

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

Marital Status

Complete only if for joint or secured credit, or applicant resides in a community property state or is relying on property located in such a state as a basis for repayment.
Applicant
Co-Applicant
 

Balance Transfer Request
Creditor Name
 Account Number
 Amount to Transfer
Applicant Initials
 Co-Applicant Initials

Disclosure Agreement

I agree to the disclosed Credit Card Terms and Conditions. *

Applicant Signature(s)

I/We hereby apply for the loan or credit described in this application. I/We certify the I/We made no misrepresentations in this loan application or in any related documents, that all information is true and complete, and that I/we did not omit any important informaiton. I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by Lender for that purpose. Lender may disclose to any other interested parties information as to Lender's experiences or Transactions with my/our account. I/We understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell all or any part of the loan. I/We futher authorize Lender to provide to any such insurer or investor any information and documentation that they may request with respect to my/our application credit or loan.
Applicant Signature *
 Date *
Co-Applicant Signature
 Date

 

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