Credit Card Application
Visa Classic
Check Type of Account Desired:
Individual Account
Joint Account
Individual Account with Authorized User
Member Account Number
Please Note: If you are applying for credit in your name only, do not complete portion on co-applicant.
Applicant: Co-Applicant:
Name (first,last,middle): Name (first,last,middle):
Home Address (Street & No.):

How Long?:
City, State, Zip:
Home Address (Street & No.):

How Long?:
City, State, Zip:
Previous Home Address (street, city, state, zip):

How Long?:
Previous Home Address (street, city, state, zip):

How Long?:
Home Phone: Home Phone:
Birth Date: Birth Date:
No. of Dependents:
Ages: 		No. of Dependents:
Ages:
Social Security No.: Social Security No.:
Driver's License No. and State: Driver's License No. and State:
Mother's Maiden Name: Mother's Maiden Name:
Gross Annual Salary: Gross Annual Salary:
Net Monthly Pay: Net Monthly Pay:
Employer:
Position:
Start Date?
Business Address/Phone:
 Employer:
Position:
Start Date?
Business Address/Phone:
Previous Employer:
Position:
How Long?
Previous Business Address/Phone:
 Previous Employer:
Position:
How Long?
Previous Business Address/Phone:
Note: Alimony, child support, or separate maintenance income need not be
revealed if you do not choose to have it considered as a basis for repaying this obligation.
Alimony, child support, separate maintenance received under:
court order
written agreement
oral understanding		 Alimony, child support, separate maintenance received under:
court order
written agreement
oral understanding
Other income:
per
Source(s) of other income:
 Other income:
per
Source(s) of other income:
Is any income listed in this section likely to be reduced in the next two years?
Yes (explain in detail on a separate sheet)
No 		Is any income listed in this section likely to be reduced in the next two years?
Yes (explain in detail on a separate sheet)
No

Have you ever filed bankruptcy?
Yes No

Have you any legal proceedings against you?
Yes No

Have you ever filed bankruptcy?
Yes No

Have you any legal proceedings against you?
Yes No

Outstanding Debts (Include charge accounts, installment contracts, credit cards, rent, mortgages, etc. Use separate sheet if necessary.)
Mortgage or Landlord:
Payment Address:
Mortgage/Rent Payment:
Original Amount:
Balance Due:
Market Value:

Autos Owned/Make:
License Number:
Year: Financed by:
Original Amount: Balance Due:
Monthly Payment:

Name and Address (Other Debts):
Account Number:
Interest Rate: Original Amount:
Balance Due: Monthly Payment:
Name and Address (Other Debts):
Account Number:
Interest Rate: Original Amount:
Balance Due: Monthly Payment:
Name and Address (Other Debts):
Account Number:
Interest Rate: Original Amount:
Balance Due: Monthly Payment:
Name and Address (Other Debts):
Account Number:
Interest Rate: Original Amount:
Balance Due: Monthly Payment:
Are you a comaker of any other loans: Yes No
Checking Account No.: Location:
Savings Account No.: Location:
$ Total:
Name of Nearest Relative Not Living With You:
Address (City, State, Zip):
Relationship:
Complete the following if you reside in a community property state (Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington or Wisconsin); or if another person will be jointly liable on the account.
Married
Separated
Unmarried
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 credit card(s) issued, the undersigned applicant(s) by signing, using or permitting another to use the credit card(s) agree(s) that the applicant(s) will be bound by the terms and conditions of the VISA agreement which will be furnished to me(us). I(We) agree to pay the credit union all reasonable costs credit union incurs to collect debts incurred under my(our) VISA agreement with credit union, or realize on any security, including reasonable attorneys' fees, court costs and collection agency fees to the extent allowed by applicable laws or regulations. I(We) understand that a contingent or hourly fee arrangement my be established under an agreement entered into by credit union with an attorney and/or collection agency to collect debts incurred under my(our) VISA agreement if it is in default and I(we) hereby agree that any such fee arrangement is reasonable. This provision also shall apply if I(we) file a petition or any other claim for relief under any bankruptcy rule or law of the United States, or if such petition or other claim for relief is filed against me(us) by another.
_______________________________
Applicant's Signature and Date 		_________________________________
Co-Applicant's Signature and Date
Balance Transfer Form
To transfer your credit balances, or pay them off, just fill in the details below. We'll send a check to each card issuer listed, and a letter to you confirming the amounts paid.*
Name of card issuer: Account Number:
Payment address of card issuer:
Phone number of card issuer:
Exact dollar ($) balance to transfer:
Name of card issuer: Account Number:
Payment address of card issuer:
Phone number of card issuer:
Exact dollar ($) balance to transfer:
Name of card issuer: Account Number:
Payment address of card issuer:
Phone number of card issuer:
Exact dollar ($) balance to transfer:
*Balance transfers take about 4 weeks to complete. Please continue to make payments on your other credit cards until the credit union notifies you that the balances have been transferred. Payment of the amount(s) authorized by you may or may not satisfy any outstanding balance(s) on the designated account(s). The credit union is not responsible for any remaining balance(s) or additional charges with regard to such account(s), nor for any charges resulting in any delay in the payment and transfer of balances. The total amount(s) paid and transferred cannot exceed your account credit line. The credit union reserves the right to refuse any balance transfer requests.
I/We the undersigned authorize Moline Municipal Credit Union to pay off the amounts specified above and apply those amounts to my Moline Municipal Credit Union credit card account.
_______________________________
Applicant's Signature		 _________________________________
Co-Applicant's Signature
Credit Union Account #
Pledge of Shares (This must be signed for a card to be issued)
By signing below, you pledge to us and grant us a security interest in all of your shareholdings with us including paid shares and future payments on shares, to secure your credit card account with us. You authorize us to apply these shareholdings to pay any amounts due on the account or under this agreement if you should default.
_______________________________
Applicant's Signature		 _________________________________
Co-Applicant's Signature
Credit Disclosure
Annual Percentage Rate (APR) for Purchases 9.99%
Other APRs Cash Advance APR: 9.99%
Balance Transfer APR: 9.99%
Grace Period for Repayment of Balances For Purchases 25 Days
Method of Computing the Balance for Purchases Average Daily Balance
(Including New Purchases)
Annual Fee None
Minimum Finance Charge None
Transaction Fee for Purchases None
Transaction Fee for Cash Advances: None
Balance Transfer Fee: None
Late Payment Fee: $20.00
Over the Credit Limit Fee: $20.00
Other Fees and Charges:
Documentation Fee: $10.00 New or Replacement Card Fee: $10.00
Returned Check Fee: $20.00 Card Recovery Fee: $65.00
FOR CREDIT UNION USE ONLY
Account No. _____________________________
Credit Limit Of $____________________ Date Approved ________________
Approved by __________________________________
Comments ________________________________________________________