Unmarried (Single, Divorced, Widowed)
Loan Applied For:
Visa Credit Card
Special Loan Other:
Desired Length of Repayment (mon):
Automatic Transfer from
Payment Protection Plan:
Would you like to purchase Credit Life Insurance:
Single Credit Life, (Only Available for Applicant)
Joint Credit Life,
Would you like to purchase Credit Disability
Single Credit Disability (Only Available for
Joint Credit Disability
you a U.S. Citizen?
you ever had a judgment, bankruptcy, repossesion, or lawsuit?
own your home or vehicle?
Home Value $
Vehicle(s) Value $
Gold 9.90% Fixed
Platinum 9.90% Fixed
Fee - $25.00
Late Payment Fee - $25.00
Cash Advance - $5.00
Replacement Card Fee - $10.00
NSF Fee - $20.00
You agree that everything
stated in this application is correct to the best of your
knowledge. The Credit Union is authorized to investigate your
creditworthiness, employment history, and to obtain a credit
report and to answer questions about their credit experience
with you. You understand that any false or misleading statement
in your application may cause any loan or extension of credit
to be in default. You authorize us to accept your facsimile
signatures on this application and agree that your facsimile
signature will have the same legal force and effect as your
original signature. You assume any risk that may be associated
with permitting us to accept your facsimile signature.
By pressing the "Send Application"
button below, you agree to the above statement. You understand
that we may require your signature on additional documents
prior to disbursing any credit proceeds.