Young Member VISA Platinum Application   Limit Requested $500.00 • Individual Account: only applicant will have use of card. • Joint Account: a VISA card with the same account number will be issued to applicant and co-applicant/co-signer in their own name.   APPLICANT   APPLICANT (primary card holder)   * required fields   Full Name * (First, Middle Initial, Last)     Date of Birth * (mm/dd/yyyy)     Mother's Maiden Name *     Social Security Number * (XXX-XX-XXXX)     Driver's License Number / State *     Phone Number(s) *    Home    Work    Cell   Email Address    (Provide only if you wish for us to contact you via email)     Street Address *    City    State    Zip How long have you lived at this address?  0 1 2 3 4 5 6 7 8 9 10 11-15 16-20 21-25 26-30 30+  Years   0 1 2 3 4 5 6 7 8 9 10 11  Months   Previous Address: (Required if you have lived at your present address for less than 2 years)  City    State    Zip     Present Employer *     Department   $ .00  (gross monthly income * )   Time at Company *   0 1 2 3 4 5 6 7 8 9 10 11-15 16-20 21-25 26-30 30+  Years 0 1 2 3 4 5 6 7 8 9 10 11  Months   (Previous employer/college - Required if current is less than 2 years)     NOTICE: Alimony, child support or separate maintenance income need not be revealed if you don’t want it considered as a basis for repaying the obligation.   Source of Other Income     $ .00 (Amount Per Month)   CO-APPLICANT/CO-SIGNER    check this box to create a joint account   * required fields   Full Name * (First, Middle Initial, Last)     Date of Birth * (mm/dd/yyyy)     Mother's Maiden Name *     Social Security Number * (XXX-XX-XXXX)     Driver's License Number / State *     Phone Number(s) *    Home    Work    Cell   Email Address    (Provide only if you wish for us to contact you via email)     Street Address *    City    State    Zip How long have you lived at this address?  0 1 2 3 4 5 6 7 8 9 10 11-15 16-20 21-25 26-30 30+  Years   0 1 2 3 4 5 6 7 8 9 10 11  Months   Previous Address: (Required if you have lived at your present address for less than 2 years)  City    State    Zip     Present Employer *     Department   $ .00  (gross monthly income * )   Time at Company *   0 1 2 3 4 5 6 7 8 9 10 11-15 16-20 21-25 26-30 30+  Years 0 1 2 3 4 5 6 7 8 9 10 11  Months   (Previous employer/college - Required if current is less than 2 years)     NOTICE: Alimony, child support or separate maintenance income need not be revealed if you don’t want it considered as a basis for repaying the obligation.   Source of Other Income     $ .00 (Amount Per Month)   CREDITORS   APPLICANT CREDITORS (Include Charge Accounts, Installment Contracts, Credit Cards, Rent, Mortgages, etc.)   Do you own a home or rent?  Own   Rent   Not Applicable     What is your monthly housing expense? $ .00 Please provide landlord/mortgage information in the provided creditor space below.     Creditors   Present Balance   1.   $ .00   2.   $ .00   3.   $ .00   4.   $ .00   5.   $ .00   6.   $ .00   7.   $ .00   8.   $ .00   9.   $ .00   10.   $ .00   Check this box if you have more than 5 creditors.  I/we certify the above to be true and correct.   CONSOLIDATION   *If the purpose of this request for a credit union VISA is to consolidate other credit cards, please complete the creditor information below. ACCOUNTS BEING CONSOLIDATED AND TRANSFERRED MUST BE PAID IN FULL AND CLOSED. Your balance transfer request may not be fulfilled if your credit line assignment is less than the balance transfer amount you requested. We caution you not to transfer the amount of any disputed purchase because you may lose your dispute rights. Please keep in mind that you are responsible for any finance charges remaining on your transferred accounts. List creditors, account number and payoffs (attach statements when mailing) to be consolidated.     Creditors Account # Payoff Balance 1. $ .00 2. $ .00 3. $ .00 4. $ .00 5. $ .00 6. $ .00  Check this box if you have more than 3 accounts to consolidate.  I/we agree to allow the Credit Union to pay these accounts in full and transfer the balances to my Credit Union Visa.         In addition, I/we certify the above to be true and correct and agree to the terms set forth above.   APPLICANT TERMS   I submit the above information to establish a credit card account with Baltimore County Employees Federal Credit Union. I certify that the information contained in this application is true and correct to the best of my knowledge. The Credit Union is authorized to verify correctness of the above information and to procure other information it may require to process this application. Both myself and co-applicant/co-signer (if applicable), are jointly liable for any credit extended on my credit card account, and are bound by the terms on the Credit Card Disclosure Statement.  I have read the disclosure and request that you establish a VISA account for me (us). If approved, I agree to be bound by the terms and         conditions of the Cardholder Agreement which will be mailed with my card.   CREDIT CARD DISCLOSURE STATEMENT   Annual Percentage Rate (APR) Annual Fees Grace Period For Purchases Minimum Finance Charge Method for Computing the Balance Fees The APR for your Card will be one of the three rates disclosed to the right and is based on certain credit-worthiness criteria 7.90% APR 9.90% APR 11.90% APR NONE 25 Days NONE Average Daily Balance Transactions: None Balance Transfer: None Card Replacement: $5 Late Payment: $15 Over Limit: $10 Foreign Transactions: 1% of transaction amount Baltimore County Employees Federal Credit Union 23 W. Susquehanna Avenue • Towson, MD 21204 • 410-828-4730 • 1-800-234-4730 • FAX 410-828-0325   For Office Use Only:     Cross Checked    Approved    Disapproved Credit Limit/Denial: _______________   Reviewed By: Date: