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VISA Credit Card Application
Co-Applicant (Please Print)
Name - Debts Name Mo. Balance Payment
Credit Limit Requested: $________
Check off: VISA Type - Pay Method Ο Ο Ο Individual Account Ο Joint Account Ο Share Secured Acct Mail In Payment “AUTO PAY” - ACH/ Direct Payment from Credit Union Share
Applicant (Please Print)
Name - Debts Name Mo. Balance Payment
Social Security No. Date of Birth Address
Social Security No. Date of Birth Address
Credit Information
Provide the following information about applicant, and if applicable, about co-applicant. If additional information is required, an additional application may need to be signed.
Applicant
City/State/Zip City/State/Zip Please check one and enter monthly payment amount. Ο Mortgage/Own home $ __________ Ο Rent $ ____________ per month. Ο Live with relative $________ per month.
Home Phone
Work Phone
Home Phone
Work Phone
Employed by: *Monthly Gross Salary $ Full-time Part-time Length of Employment: Years **Other Income $ Source of Income: Name of nearest relative
(not living with you)
Mos.
Employed by: *Monthly Gross Salary $ Full-time Part-time Length of Employment: Years **Other Income $ Source of Income: Name of nearest relative
(not living with you)
Co-Applicant
Please check one and enter monthly payment amount. Ο Mortgage/Own home $ __________ Ο Rent $ ____________ per month.
Mos.
Annual Percentage Rate Annual Fee Method of Computing the Balance
11.90% Fixed NONE
Average Daily Balance (including new purchases) 25 days for the repayment of purchase balances (grace period does not apply to cash advances) Late Payment: $10.00 Over Credit Limit: $10.00 Card Replacement: $ 3.00 Returned Check: $10.00 Copy of Draft: $ 4.00 Statement Copy: $ 3.00 Cash Advance Fee: None
Address City/State/Zip Relationship
Phone
Address City/State/Zip Relationship
Phone
Grace Period
*Attach copy of W-2, payroll stub, etc., to verify income. **Alimony, child support or separate maintenance income need not be revealed if you do not choose to have it considered.
*Attach copy of W-2, payroll stub, etc., to verify income. **Alimony, child support or separate maintenance income need not be revealed if you do not choose to have it considered.
Other Fees
By completing this form and mailing (or faxing) it in, I/We agree to be bound by the Member VISA Agreement which you will send to me. If I/We do not agree to be bound by such agreement, I will immediately cut the cards in half and notify you in writing that I have done so, all before the first use of the card(s). I understand that a credit report may be obtained from one or more consumer reporting agencies (credit bureaus) for approval of this request. I/We have read and understand the disclosure on the right side of this application.
Signature of Applicant Signature of Co-Applicant
Date___________ Date___________ For office use only: Date: Special Terms/Comments:
Federal Reserve Boston Employees Federal Credit Union
600 Atlantic Ave. 4th Flr., Boston, MA 02106 Phone: (617) 973-3760 WEBSITE: http://www.frbefcu.org/
Approved: Disapproved: