Credit Card Application

EQUAL CREDIT OPPORTUNITY ACT NOTICE
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal Agency that administers compliance with this law concerning this creditor is: Regional Director, National Credit Union Administration, 7000 Central Parkway, Suite 1600, Atlanta, Georgia 30328.

Loan Application Fee : $2.00

* = Required

OFCU Account Number:*

Credit Card Amount Requested:

$

Name:*

Street Address:

City:

State:

Zip:

How Long:

Date of Birth:

Phone Number:*

Previous Address:

How Long:

Email Address:*

Social Security Number:

Drivers License Number:

NOTE: Please include your most current payroll stub or, if self-employed, your most recent Federal Tax Return.

Employer:

Date Hired:

Supervisor Name:

Position:

Current Gross Pay:

$ per Hourly Weekly Bi-weekly Bi-monthly Monthly Annually

Employer's Address:

Phone Number:

Previous employer:

(Required is current position is less then 3 years.)

Position:

Gross Salary:

$

Date Hired:

Supervisor:

Length of Time on the Job:

Previous Employer's Address:

Phone Number:

Notice: Income from alimony, child support, or separate maintenance payments need not be revealed if you do not choose to have it considered.

Other Income:

$ --Choose Frequency-- weekly bi-weekly monthly

Source:

Co-Applicant/Other Applicant:

Social Security Number:

Date of Birth:

Employer:

Work Phone:

Address:

Current Gross Pay:

$ per Hourly Weekly Bi-weekly Bi-monthly Monthly Annually

Date Hired:

Position:

Supervisor:

Notice: Income from alimony, child support, or separate maintenance payments need not be revealed if you do not choose to have it considered.

Other Income:

$ --Choose Frequency-- weekly bi-weekly monthly

References

Parent or Relative Not Living in Same Residence:

Relationship:

Street Address:

City:

State:

Zip:

Phone:

Name of Second Reference:

Relationship:

Street Address:

City:

State:

Zip:

Phone:

Name of Third Reference:

Relationship:

Street Address:

City:

State:

Zip:

Phone:

Assets

Home Value:

$

Vehicle (year and make):

Vehicle (year and make):

Other Savings Account (bank and balance):

$

Other Checking:

$

Other Assets (type and value):

$

LIST ALL OUTSTANDING OBLIGATIONS: (include: house payments, installment accounts, doctor bills, finance companies, charge accounts, etc.) Attach additional page if all creditors do not fit in space provided below.

Are there any judgements, garnishments, collections or legal proceedings against you?

--Select-- yes no

If yes, explain:

Have you ever filed bankruptcy?

If yes, give year:

Are you a co-maker on a loan?

If yes, for whom?

Loan Balance:

Monthly Payment:

Terms and Agreement

Please check the box if you agree to the Terms and Agreement.

Note: if the maximum loan repayment period is greater than 120 months, loans with periods in excess of 120 months will be insured for full life coverage only during the first 120 months. Disability coverage will remain in effect for the entire re payment period of up to 120months but a maximum of only 60 monthly benefits are payable.

Credit Insurance Applied for:

Notice to Applicant(s)

I (we) are applying for the credit insurance coverage (s) selected above and agree to pay the required premium. I (we) understand that fees may be paid by the insurer in connection with coverage to the sponsor of this plan and/or its affiliates or designates. I (we) understand this insurance is voluntary and that I (we) may terminate it at any time. I (we) also agree that:
1. I am eligible for life insurance if I am presently under age 71.
2. If joint life insurance is selected, we a re eligible if the older application is presently under age 71. We must be jointly and individually liable under the loan. Co-signers or guarantors are not eligible for insurance.
3.I am eligible for disability insurance if I am presently under age 66. I also must be presently employed outside the home for wages or profit for 30 or more hours a week and have been employed for 30 days or more before this date.
4. The person signing this application as co-applicant is not eligible for disability insurance.

The following question must be answered to determine my (our) eligibility for insurance:
During the last two years, have you or your co-applicant been advised of or treated for cancer, heart attack or coronary artery disease, stoke, or cirrhosis; or have you or your co-applicant been diagnosed for Acquired Immune Deficiency Syndrome(AIDS)?
Please Check One:

Primary Applicant		Co-Applicant
No	Yes	No	Yes

My (our) answer to the above question is true to the best of my (our) knowledge and belief. If either my co-applicant or I answer "Yes" to this question, we understand that we are not eligible for insurance and will not be insured. The effective date of my (our) insurance will be the date of this application, that date the eligible loan is disbursed, or the date the note evidencing the loan is signed, whichever date is later.
Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing false, incomplete, or misleading information is guilty or a felony of the third degree.

By submitting this electronic application, you agree to the same terms that apply to a signed application. If there is a co-applicant on this request, that co-applicatant has authorized the submission of this application and both of you desire the credit account to be joint. The electronic submission of this application qualifies as your signature(s).