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ONLINE BANKING

Visa Platinum Credit Card Application

Have an unexpected purchase or splurging for a gift? Apply for a Community Healthcare FCU Credit Card!

Questions? Call us at (425) 259-6446.

Credit limit requested

Check account choice:

Signature required for joint applicant

Individual account

Joint account

Credit line increase

We intend to apply for joint credit

co-applicant initials

Important information about procedures for opening a new account: To help the government fight the funding of terrorism and money laundering activities, Federal laws require all financial institutions to obtain, verify and record information that identifies each person who opens an Account. What this means to you: When you open an Account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also to see your driver's license or other identifying documents.

APPLICANT Note: All applicable sections should be filled out completely to avoid delay in processing your application.

Name

First Name

Last Name

Social Security Number

Date of birth

YYYY

Current address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Monthly payment

How long?

(Years)

Employer name

Self employed

Yes

Date employed

YYYY

How Long?

(Years)

Source of additional income:

Income from alimony, child support or separate maintenance need not be revealed if it is not considered in determining creditworthiness

$ Amount per month

Nearest relative

(Not living with you)

First Name

Last Name

Home phone

(###)

###

####

Relationship

CO-APPLICANT: Intended for joint applicant, this information is not required for an individual account.

Name

First Name

Last Name

Social Security Number

Date of birth

YYYY

Phone

(###)

###

####

Current address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer name

Self employed

Yes

Work phone

(###)

###

####

Date employed

YYYY

Position/occupation

Monthly gross income

Home mortgage/rent

SIGNATURES

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING: This statement is submitted to obtain credit and I/we certify that all information herein is true and complete. I/We agree that inquiries may be made to verify information and that credit references or verification may be given based on inquiries from other parties. This offer is subject to the credit policies of this institution. I/We agree to be bound by the terms and conditions of the cardholder agreement, a copy of which will be mailed to the applicant if this application is granted, receipt of such agreement and acceptance of such terms to be conclusively presumed by the applicant's use. If you intend to apply for joint credit, the undersigned shall be jointly and severally liable for any and all credit extended from time to time. We may report information about your account to the credit bureaus. Late payments, missed payments, or other defaults on your account may be reflected in your credit report.

Applicant signature

Date

YYYY

Co-applicant signature

Date

YYYY