APPLICATIONS MENU VISA CREDIT CARD
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NOTE: 3 Forms: 1. Loan Requirements 2. Loan Application 3. Credit Report Inquiry Release (Print all forms) Rev 4/23
Thank you for showing an interest in our VISA credit card.
In order to be considered for a loan, the following are needed: 1____ Completed Loan Application 2____ Signed Credit Report Inquiry Release 3____ Copies of last 3 paycheck stubs (if retired, copy of Social Security check) 4____ Copies of last year's W-2 (if self-employed, 3 years Income Tax Returns) 5____ Steady employment for at least 12 months 6____ Copy of a U.S. Government Issued photo ID, i.e. Driver's License or Passport or Alien Registration (Green) Card 7____ A fee of $10.00 for the Credit Report
UKRAINIAN SELFRELIANCE FEDERAL CREDIT UNION 1729 Cottman Avenue Philadelphia, PA 19111-3888 (215) 725-4430
A table that includes the APRs and other required cost disclosures for credit card applications is below the application
VISA CREDIT CARD APPLICATION Return completed application to credit union An incomplete or unsigned application may delay processing
Check below to indicate the type of credit for which you are applying. Married applicants may apply for a separate account. Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if: 1. You live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI). 2. Your spouse will use the account, or 3. You are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about the person on whose payments you are relying. Joint Credit: Each applicant must individually complete the appropriate section below. If Co-Borrower is spouse of the Applicant, mark the Co-Applicant box. GUARANTOR: Complete the Other section if you are a guarantor on an account/loan
Applicant NAME (Last - First - Initial) MOTHER'S MAIDEN NAME
Other: Guarantor
Co-Applicant
Spouse MOTHER'S MAIDEN NAME
NAME (Last - First - Initial)
ACCOUNT NUMBER
SOCIAL SECURITY NUMBER
ACCOUNT NUMBER
SOCIAL SECURITY NUMBER
DRIVER'S LICENSE NUMBER / STATE BIRTH DATE HOME PHONE WORK PHONE/EXT.
DRIVER'S LICENSE NUMBER / STATE BIRTH DATE HOME PHONE WORK PHONE/EXT.
E-MAIL ADDRESS
E-MAIL ADDRESS
PRESENT ADDRESS (Street - City - State - Zip
OWN
RENT YEARS AT THIS ADDRESS
PRESENT ADDRESS (Street - City - State - Zip)
OWN
RENT
YEARS AT THIS ADDRESS
PREVIOUS ADDRESS (Street - City - State - Zip)
OWN
RENT YEARS AT THIS ADDRESS
PREVIOUS ADDRESS (Street - City - State - Zip)
OWN
RENT
YEARS AT THIS ADDRESS
MORTGAGE/RENT OWED TO: MORTGAGE BALANCE $ $ COMPLETE FOR JOINT CREDIT, SECURED CREDIT, OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE: MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed) MONTHLY PAYMENT NO. OF DEPENDENTS AND AGE
MORTGAGE/RENT OWED TO: MORTGAGE BALANCE $ $ MONTHLY PAYMENT NO. OF DEPENDENTS AND AGE
COMPLETE FOR JOINT CREDIT, SECURED CREDIT, OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE: MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)
Employment/Income NAME AND ADDRESS OF EMPLOYER START DATE POSITION
Employment/Income NAME AND ADDRESS OF EMPLOYER START DATE POSITION
NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED
EMPLOYMENT INCOME $_________________PER___________ NET GROSS
OTHER INCOME $__________________PER_______________ SOURCE
EMPLOYMENT INCOME $_________________PER___________ NET GROSS
OTHER INCOME $__________________PER_______________ SOURCE STARTING DATE ENDING DATE
NAME AND ADDRESS OF PREVIOUS EMPLOYER DATE
STARTING NAME AND ADDRESS OF PREVIOUS EMPLOYER
ENDING DATE Deposit Account Name & Account Number SAVINGS CHECKING Other Assets OTHER PROPERTY OTHER AUTO MAKE YEAR $ $ $ $ VALUE Creditor Name & Account Number CREDITOR CREDITOR CREDITOR CREDITOR AUTO OTHER $ $ $ $ $ $ YES 1. ARE YOU A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN? 2. DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT PLAN CONFIRMED UNDER CHAPTER 13, HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS, OR BEEN A PARTY IN A LAWSUIT? 3. ARE YOU A CO-MAKER, CO-SIGNER OR GUARANTOR ON ANY LOAN NOT LISTED ABOVE? FOR WHOM (Name of Others Obligated on Loan): TO WHOM (Name of Creditor): Personal Reference RELATIONSHIP: HOME PHONE: BALANCE MONTHLY PAYMENT $ $ $ $ $ $ APPLICANT NO OTHER YES NO
Other Information About You
IF YOU ANSWER "YES" TO ANY QUESTION OTHER THAN #1, EXPLAIN ON AN ATTACHED SHEET
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU: State Law Notices OHIO RESIDENTS ONLY: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law. WISCONSIN RESIDENTS ONLY: (1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned. .X____________________________________________________________________________ SIGNATURE FOR WISCONSIN RESIDENTS ONLY DATE SIGNATURES You promise that everything you have stated in this application is correct to the best of your knowledge and that You understand that the use of your card will constitute acknowledgment of receipt and agreement to the terms of the the above information is a complete listing of what you owe. If there are any important changes you will notify us credit card agreement. A condition of your account is your granting us a security interest in all individual and joint in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application share and/or deposit accounts you have with us now and in the future to secure your credit card account. Shares and for credit and for any update, increase, renewal, extension, or collection of the credit received. You understand that deposits in an Individual Retirement Account, and any other account that would lose special tax treatment under state the Credit Union will rely on the information in this application and your credit report to make its decision. If you or federal law if given as security, are not subject to the security interest you have given in your shares and deposits. request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit When you are in default we may apply the balance in these accounts to any amounts due under the credit card report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan agreement. applications made to federal credit unions or state chartered credit unions insured by NCUA. X____________________________________________________________________________ X__________________________________________________________________________________________ OTHER SIGNATURE DATE APPLICANT'S SIGNATURE DATE FOR CREDIT UNION USE ONLY APPROVED NO. OF CARDS_________ DECLINED CREDIT LIMIT $________________ CREDIT CARD NUMBER_________________________________________
CREDIT COMMITTEE OR LOAN OFFICER SIGNATURE___________________________________________________________________
TABULAR DISCLOSURE Annual Percentage Rate (APR) for Purchases Other APRs Grace Period for Purchases Method of Computing the Balance for Purchases VISA Classic 11.9% Cash Advance....11.9% 25 Days Average Daily Balance
(Including New Purchases) Annual Fee None Minimum Finance Charge None Foreign Transaction Fee....................................................1%* Late Payment Fee........................................................$10.00 Over-the-Credit Limit Fee............................................$10.00 *of Transaction amount. The information about the costs of the card described in this application is accurate as of 7/2006. This information may have changed after that date. To find out what may have changed, contact the credit union.
Ukrainian Selfreliance Federal Credit Union CREDIT REPORT INQUIRY RELEASE
I certify that all information given in this application and on any attachment, both written or printed is true and correct to the best of my knowledge, and represents my current financial conditions accurately, and that I have no other debts other than those stated. It is agreed that the application shall be the property of the credit union whether or not this loan is granted. If there are important changes, I will notify the credit union in writing immediately. I understand that my false statements, or willful overvaluation of any land, property or security, for the purpose of influencing in any way the action of any Federal Credit Union upon any loan application, is a violation of Section 1014, Title 18, U.S. Code. I authorize the credit union to gather whatever credit information that is considered necessary to appropriate. In considering this application, the credit committee/loan officer may request, and use a report from outside credit report agencies. They may also ask a reporting agency or agencies for other such reports in connection with renewal or continuation of the credit for which I/we are applying. I authorize the credit union to give information concerning its credit experience with myself to others. If this application is signed by more than one person, the word "I" shall mean all those who sign the application.
x______________________________ Applicant's Signature Date
x______________________________ Spouse/Co-Applicant Signature Date
x______________________________
Witness