FCI FEDERAL CREDIT UNION
PO Box 620092
Littleton, CO 80162-0092
(303) 763-2555
Fax: (303) 763-2559
www.fcifcu.org

that

disclosures

includes
is
To obtain

A table
card
Application.
required
call us at (303) 763-2555
stated
address

information

with

required

provided
any
since

credit
this
in the
printed,
or write to us at the

change
it was

on this Application.

VISA

Credit Card Application

the type of credit

Check below to indicate
account.
o Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if: (1) you live in or the property
(2) your spouse will use the account; or
If you are relying on income from alimony, child support, or separate

for which you are applying. Married Applicants may apply for a separate

property state (AK, AZ, CA, 10, LA, NM, NV, TX, WA, WI);

pledged as collateral
(3) you are relying on your spouse's income as a basis for
maintenance,

complete the Other section to the extent possible about

the person on whose payments you are relying.

is located in a community

repayment.

individually complete the appropriate

section below.

If Co-Borrower

is spouse of

the applicant, mark the

o Joint Credit: Each applicant must
box.

Co-Applicant

Guarantor: Complete the Other section if you are a guarantor on an account/loan .

•

DRIVER'S LICENSE NUMBER / STATE

DRIVER'S LICENSE NUMBER / STATE

E·MAIL ADDRESS

E·MAIL ADDRESS

BIRTH DATE

HOME PHONE

BUSINESS PHONE! EXT.

BIRTH DATE

HOME PHONE

BUSINESS PHONE! EXT.

PRESENT ADDRESS (Street· cav- Stata- Zip)

(

)

PRESENT ADDRESS (Street· City· State· Zip)

(

)

MORTGAGE/RENT OWED TO:

MORTGAGE/RENT OWED TO:

MORTGAGE BALANCE

MONTHLY PAYMENT

INTEREST RATE

MORTGAGE BALANCE

MONTHLY PAYMENT

INTEREST RATE

~$~~~~~~~$~==~==~~~~~~~~--~%
COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY
PROPERTY STATE:
MARRIED

SEPARATED

Employment/Income
NAME AND
ADDRESS OF ..
EMPLOYER

. . . . . . . . . . .

$
COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY
PROPERTY STATE:
MARRIED

SEPARATED

$

%

Employment/Income
NAME AND
ADDRESS OF
EMPLOYER

.

NOTICE: ALIMONY, CHILO SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED

NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED

IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.

IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.

EMPLOYMENT INCOME

OTHER INCOME

EMPLOYMENT INCOME

OTHER INCOME

$

SOURCE

PER

_

_

~~

__

PER

_

$

PER

_

,!,,}~o~:icE~sIjllJdiscrimination

OHIO RESIDENTS ONLY: The Ohio laws against
require that all creditors make
all
available

creditworthy

equally

to

--' credit

and that credit
on each individual

reporting
upon

agencies maintain separate credit
The Ohio Civil Rights
request.

administers

compliance with this law.

1--
customers,
histories
Commission

WISCONSIN RESIDENTS ONLY: (1) No provision of any marital property
agreement, unilateral statement under Section 766,59, or court decree under

GROSS

SOURCE

Section 766.70 will adversely affect the rights of the Credit Union unless the
Credit Union is fumished a copy.ot
the agreement, statement or decree, or
has actual knowledge of its terms, before the credit is granted or the account
is opened, (2) Please sign if you are not applying for this account or loan with
your spouse. The credit being applied for,
if granted, will be incurred in the
interest of the marriage or family of the undersigned,

Ix

SIGNATURE FOR WISCONSIN RESIDENTS ONLY

DATE

Signatures

to the best of your knowledge.

If there are any important changes

is unions insured by NCUA,
2. You understand

reports in connection with this application for credit and card agreement and disclosures. You grant us a security interest
increase,

1. You promise that everything you have stated in this application
correct
you will notify us in writing immediately, You authorize the Credit Union acknowledgment of receipt and agreement
to obtain credit
for any update,
received. You understand that the Credit Union will
in this application
request,
the Credit Union will
bureau from which it received a credit
to willfully and deliberately provide incomplete or incorrect
loan applications made to federal credit unions or state chartered credit

constitute
to the terms of the credit
in
individual and joint share and/or deposit accounts you have with
all
us now and in the future to secure your credit card account. When you
If you are in default, you authorize us to apply the balance in these accounts
to any amounts due. Shares and deposits in an Individual Retirement
tax treatment
law if given as security, are not subject to the

It is a federal crime Account, and any other account that would lose special

security interest you have given in your shares and deposits.

the credit
rely on the information

tell you the name and address of any credit

information on under state or federal

renewal, extension, or collection of

the use of your card will

to make its decision.

and your credit

report on you.

report

that

I~IX=====~(S~EAL)==:;;!,IIIIX

APPLICANT'S SIGNATURE

DATE

OTHER SIGNATURE

(SEAL)

II

DATE

FCI FEDERAL CREDIT UNION
PO Box 620092
Littleton, CO 80162-0092
(303) 763-2555
Fax: (303) 763-2559
www.fcifcu.org

Int:erest Rates ancilnterest

''i;''

Annual Percentage Rate (APR)
Purchases

for

Charges
11.90%

u,
VISA

VISA CLASSIC
Application and Solicitation Disclosure
@!'

!qil~

'it

@

if:

APR for Cash Advances

APR for Balance Transfers

Penalty APR and When it Applies

Minimum Interest Charge

How to Avoid Paying Interest on
Purchases

For Credit Card Tips from the Federal
Reserve Board

FeE;'s

rlf'

",,,

"!

'1"",,,

""s~

I)
c

s

11.90%

11.90%

None

None

Your due date is at least 25 days after the close of each billing cycle,
if you pay your entire
We do not charge you interest on purchases
balance by the due date each month.

To learn more about
a credit card, visit
http://www.federalreserve.gov/creditcard.

factors to consider when applying for or using

the Web site of the Federal Reserve Board at

If",

",.

!'

Set-up and Maintenance
• Annual Fee
• Account Maintenance Fee on Closed

Fees

None
None

Accounts

Fees

Transaction
• Cash Advance Fee
• Foreign Transaction Fee

Penalty Fees
• Late Payment Fee
• Over-the-Credit Limit Fee
• Returned Payment Fee

None
None

None
None
$15.00

How We Will Calculate Your Balance. We use a method called "average daily balance (including new purchases)."

Effective Date. The information
December
contact

the Credit Union.

is accurate as of
30, 2009. This information may have changed after that date. To find out what may have changed,

the card described

in this application

the costs of

about

OTHER DISCLOSURES

Statement Copy Fee
Document Copy Fee
Rush Fee
Emergency Card Replacement Fee
Card Recovery Fee
Pay By Phone Fee
Card Replacement Fee
PIN Replacement Fee
FedEx Fee

None
$12.00
$25.00
$150.00
$65.00
$5.00
$15.00 per card
$3.00
$30.00

Please return completed
Application to the address
below in a stamped envelope.

Cut off the Application and
Solicitation Disclosure
and retain for your records.

FCI FEDERAL CREDIT UNION
PO BOX 620092
LITTLETON CO 80162-0092

Credit Caid""'-'!!i"~
Application

FCI FEDERAL CREDIT UNION
PO Box 620092
Littleton, CO 80162-0092

(303) 763-2555
Fax: (303) 763-2559
www.fcifcu.org

© CUNA MUTUAL GROUP, 2009,
ALL RIGHTS RESERVED

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