MONROE COUNTY COMMUNITY CREDIT UNION APPLICATION FOR VISA BUSINESS CARD
Business Member Share Account Number _________________________________________ Requested Credit Limit $_____________________________
Business Information
Name of Business (Borrower)
Name of Business as you would like it to appear on your Card TIN #
Business Address City State Zip
Business Phone Business Fax Home Phone
Legal Form of Business (circle one) Sole Propietor/DBA Partnership C Corp. S. Corp. LLC Other__________________________
Date Busienss Started Date of Present Ownership
Owner Information
1 - Owner Name % Owned Title
2 - Owner Name % Owned Title
3 - Owner Name % Owned Title
4 - Owner Name % Owned Title
Personal Guarantor Information
Name Date of Birth Name Date of Birth
Address Address
Phone No. Social Security # Phone No. Social Security #
Monthly Inocme Source of Income* Monthly Income Source of Income*
*Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Business Account References
Financial Instituion Account # Average Monthly Balance
Financial Instituion Account # Average Monthly Balance
Current Business Debts (please attach additional pages if needed)
Financial Instituion Loan Type: (Circle One) Monthly Pmt. Original Balance Current Balance Collateral
Line of Credit Term $ $ $
Financial Instituion Loan Type: (Circle One) Monthly Pmt. Original Balance Current Balance Collateral
Line of Credit Term $ $ $
Business History
(the following questions refer to the business entity applying for credit - please attach additional pages if needed)
Have you every been involved in any bankruptcies or assignments in the Do you have any outstanding Are you involved in any lawsuits? Do you have any delinquent loans or
last 10 years? Yes No judgments or liens? Yes No trade accounts?
Yes No Yes No
Have any officers, directors, key managers or owners of 20% or more of the business ever Are any officers, directors, key managers or owners of 20% or more of the business
been convicted of any criminal offense other than minor traffic violations? presently under indictment or on parole or probation?
Yes No Yes No
Authorized User Information
If this application is approved, credit cards will be issued to the following authorized users. Each card will be embossed with the Business Name and the Name of the Authorized User. Each
authroized user listed below shall remain authorized to use the Account until written notice to the contrary is received by the credit union.
Authorized Signature Printed Name and Title
X
Address Home Phone Business Phone
Authorized Signature Printed Name and Title
X
Address Home Phone Business Phone
Authorized Signature Printed Name and Title
X
Address Home Phone Business Phone
Authorized Signature Printed Name and Title
X
Address Home Phone Business Phone
Application and Agreement
All those signing below certify to the best of their knowledge that the above statements are true and accurate. In addition, the individual signing below submit this application for a Monroe
County Community Credit Union VISA Business Credit Card Account, and agree that, upon approval by the credit union, the business named above will comply with the terms and
conditions of the Monroe County Community Credit Union VISA Business Credit Card Agreement (the "Agreement"), a copy of which I/we acknowledge receiving. The undersigned
guarantors agree that the Credit union may report the undersigned's liability for and the status of the account to credit bureaus and others who may lawfully receive such information, and
they authorize the Credit Union to verify or obtain further information as it may deem necessary concerning the entity, including thorugh the use of reports obtained from the consumer or
commercial reporting agencies. The undersigned further represent that they are authorized by the Business Member to bind it to the terms and conditions of the Agreement, and that the
Cards issued pursuant to this Agreement will be used solely for business purposes, including commercial, industrial and professional purposes, and NOT for personal, family or household
purposes.
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Signature Title Date
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Signature Title Date
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Signature Title Date
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Signature Title Date
Personal Guaranty
The undersigned Guarantors, hereby absolutely and unconditonally guaranty prompt payment when due and at all times thereafter of any and all existing and future indebtedness and
liabilities of every nature and kind, including all renewals, extensions and modifications thereof, now or hereafter owing from Borrower to Credit Union, under the Terms and conditions of
the Monroe County Community Credit Union VISA Business Card Agreement and disclosures (the "Agreement). The undersigned Guarantors waive notice of the acceptance of this
Guaranty and of all extensions of credit hereunder. The undersigned Guarantors further waive presentment, protest, notice demand, or action of any nature on any delinquency with
respect to the indebtedness, including the right to require the creditor to sue or otherwise enforce payment thereof, or to enforce any other security or other guaranty given therefor. The
undersigned Guarantors agree that this guaranty shall remain in force until the Agreement has terminated and all amounts due thereunder shall have been paid in full. The undersigned
guarantors agree that the Credit Union may report the undersigned's liability for, and the status of, the Account to credit bureaus and others who may lawfully receive such information, and
authorize the
they authorize theCredit Union to verify or obtain further information as it may deem necessary concerning the identity or credit worthiness of the individuals below, including through the
use of reports obtained from consumer reporting agencies.
X
Signature Title Date
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Signature Title Date
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Signature Title Date
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Signature Title Date