Great Horizons Federal Credit Union
VISA Application

New Card Desired Credit Limit
Increase Credit Limit On Existing Card to
Applicant
Co-Applicant
Name: Name:
Home Address (Street and No.):
Home Address (Street and No.):
City, State, Zip Code:
City, State, Zip Code:
How Long?
How Long?
Home Phone: Home Phone:
Birth Date: SSN: Birth Date: SSN:
E-mail Address : E-mail Address :
Current Employer: Current Employer:
Gross Annual Income: Gross Annual Income:
Net Monthly Pay: Net Monthly Pay:
Other Income: Other Income:
Business Phone: Business Phone:
Title/Grade/Rank: Title/Grade/Rank:
Start Date: Start Date:
Self Employed: Yes No Self Employed: Yes No
Business Address: Business Address:
Notice: 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.
Debts
Applicant
Other
Creditor Name & Address:
Present Balance:
Monthly Payment:
Applicant
Other
Creditor Name & Address:
Present Balance:
Monthly Payment:
Applicant
Other
Creditor Name & Address:
Present Balance:
Monthly Payment:
Applicant
Other
Creditor Name & Address:
Present Balance:
Monthly Payment:
Applicant
Other
Creditor Name & Address:
Present Balance:
Monthly Payment:
Applicant
Other
Creditor Name & Address:
Present Balance:
Monthly Payment:
Applicant
Other
Creditor Name & Address:
Present Balance:
Monthly Payment:
Financial Information - If a "YES" is given to a question, please provide explanation in the comment area below.
Applicant
Other
Do you have any outstanding judgments?
Yes No
Yes No
Have you ever filed for bankruptcy or had a debt adjustment plan confirmed under Chapter 13?
Yes No
Yes No
Have you had property foreclosed upon or repossessed in the last 7 years?
Yes No
Yes No
Are you a Party in a lawsuit?
Yes No
Yes No
Are you other than a U.S. Citizen or permanent resident alien?
Yes No
Yes No
Is your income likely to decline in the next two years?
Yes No
Yes No
Are you a co-maker, co-signer or guarantor on any loan not listed above?
Yes No
Yes No

For Whom?

To Whom (Name of Creditor)?
Comments:
.
Check coverage(s) desired. The credit union will disclose the cost of this voluntary insurance to you. A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective. I am interested in Credit Life Insurance on the loan:
Yes, Single Credit Life
Yes, Joint Credit Life
No, Not Interested
.
To review terms and conditions please click here.
.

A consumer credit report may be requested in connection with this application and with any renewals, updates, or extensions of any new credit extended as a result of this application. The credit union is relying on what you stated in this applicaion and you acknowledge that everything you have stated is true and correct and that you have provided a complete listing of all you debts and obligations. By signing below you agree to the terms of the cardholder agreement that is provided with this application.

____________________________________
Applicant's Signature and Date

____________________________________
Co-Applicant's Signature and Date

By clicking on "Send Application", I accept all Terms and Conditions/Disclosures associated with this loan request.
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