Credit Card Application

Are you a current member of BlueOx Credit Union?

Yes

No

If yes, provide account number here.

You will need to become a member to open a BlueOx Credit Union Credit Card. After you submit this form, a BlueOx Credit Union Member Service Advisor will contact you about opening an account.

First Name *

Last Name *

Birthday *

Social Security *

Personal Information

Employer Name *

Employer Start Date *

Job Title *

Annual Income *

Address Line 1 *

Address Line 2

City *

ZIP Code *

Rent, own, or live with others *

monthly housing payment *

Years at residence *

Phone *

Reference 1 Name *

Ref 1 Phone Number *

Ref 1 Relationship *

Reference 2 Name *

Ref 2 Phone Number *

Ref 2 Relationship *

Co-Applicant:

Add Co-Applicant?

Yes

No

Coapp First Name

Coapp Middle Initial

Coapp Last Name

Coapp Birthday

Coapp Social Security

Coapp Employer Name

Coapp Annual Income

Coapp Address Line 1

Coapp Address Line 2

Coapp City

Coapp Phone

Credit Card Information

Credit Limit Requested *

Do you have balances on other credit cards that you would like to transfer to your new BlueOx Credit Union Credit Card, if approved? *

Yes

No

If yes, please enter the card number, balance, creditor and payoff address.

Disclosures

I/We authorize BlueOx Credit Union to pull my/our credit for the purposes of qualifying me/us for credit. I/We also certify, by checking the box to the left that I/we have read and understand the disclosures above. We may contact you in relation to this application for additional information and other potential savings we may have available for you.

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Please click the "Submit" button below to confirm your credit card application was submitted.

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