Business Visa Application

Application for VISA Business Card

Member Share Account Number *

Request Credit Limit *

Before you apply, you must be an authorized representative, partner, officer, or agent of the Business to submit this application. If the information is incomplete, we may not be able to approve the application. Please note: You, the Business, and all Authorized Users shall be liable for all charges and balances on the account. Federal Law requires us to verify the business name, street address, and tax identification number.

Legal Name of Business *

Name of Business* (as you would like to appear on your card) *

If other, please explain

Years in Business *

Street Address *

City *

Zip *

Business Phone Number *

Primary Contact *

Type of Business *

Annual Revenue *

Federal Tax ID Number *

Tell Us About Yourself

First Name *

Middle Initial *

Last Name *

Title *

Annual Salary *

Social Security Number *

Date of Birth *

Street Address *

City *

Zip *

Home Phone Number *

Email Address *

Authorized User (Optional):

First Name

Middle Initial

Last Name

Title

Annual Salary

Social Security Number

Date of Birth

Street Address

City

Zip

Home Phone Number

Email Address

Authorized User 2 (Optional):

First Name

Middle Initial

Last Name

Title

Annual Salary

Social Security Number

Date of Birth

Street Address

City

Zip

Home Phone Number

Email Address

Authorized User 3 (Optional):

First Name

Middle Initial

Last Name

Title

Annual Salary

Social Security Number

Date of Birth

Street Address

City

Zip

Home Phone Number

Email Address

Has your credit (or that of the Business) been delinquent (more than 3 months)? *

Yes

No

Are there any unsatisfied judgments against you or the Business? *

Yes

No

This statement is submitted to obtain credit and I/we certify that all information herein is true and complete. I/We also authorize the Credit Union to verify or obtain further information the Credit Union may deem necessary concerning my/our credit standing. If this application is approved and a Visa card(s) issued, the undersigned applicant(s) by signing, using, or permitting another to use the Visa card(s) agree(s) that the applicant(s) will be bound by the terms and conditions accompanying the Visa card(s) and all amendments. By clicking “Submit” below, you agree that this Credit Union has a security interest pledge, in all future shares, share drafts, and deposits with us. To the extent in which you have a right to withdraw those sums for your personal use, the Credit Union may transfer from any deposit account to your Visa account if you are delinquent or otherwise in default. In addition, collateral securing your other loans with the Credit Union account(s) will also secure credit extended under this agreement. If you withdraw all your shares, you are no longer a member of the Credit Union, and you may not receive any more advances under this agreement.

Primary Applicant *

I acknowledge and agree that all information above is accurate and that I have read and agree to the terms and conditions of the Visa Credit Card Agreement and Disclosures below.

Visa Credit Card Agreement and Disclosures

Thank You