Chetco Federal Credit Union Credit Card Application

Fields marked with * are required

Be sure to check the appropriate box under "Type of Account Requested" at the top of the application form. APPLICATION MUST BE COMPLETELY FILLED OUT! If application is not complete, loans will not be processed.
*Credit Limit: $ *Loan Type: VISA Number of Cards:
*Type of Account Requested
If you are applying for an individual account in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested do not complete Co-Applicant Section. If you are applying for a joint account or an account that you and another person will use, complete all Sections. If you are applying for an individual account, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete all Sections to the extent possible, providing information in Co-Applicant Section about the person on whose alimony, support, or maintenance payments or income or assets you are relying. If a member resides in a community property state or income is derived from a community property state, all Sections of the application should be completed.
APPLICANT INFORMATION
*Last Name: *First Name: Middle Name:
*Account Number: *SSN: Email:
*Date of Birth:
(MM-DD-YYYY)
*DL Number:
*State:
*Present Address:
Apt:
City:
State: Zip:
*Years at Address:
* Own Rent
Payment:
Previous Address:
(* If at present address less than 2 years)
Apt:
City:
State: Zip:
Years at Address:
* Own Rent
Age of Dependants: *Home Phone:
*Work Phone:
*Present Employer: *Date Hired:
*Gross Monthly Income: Other Income:
*Previous Employer: *How long employed: years
*Name/Address of Nearest Relative:
Last Name:
First Name:
Address: Apt:
City:
State: Zip:
*Relationship:
*Home Phone:
*Personal Reference Name/Address:
Last Name:
First Name:
Address: Apt:
City:
State: Zip:
*Relationship:
*Home Phone:
*Please indicate marital status if you reside in a community property state:
AZ, CA, ID, LA, NM, NV, TX, WA, WI
Married | Separated | Unmarried
Additional Information
How would you prefer to be contacted?
Home Phone
Work Phone
Email Address
Other 		Special Instructions/Comments
Income verification is required; other information may be required.

I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this credit union, information concerning me or my affairs.(Sec. 1014, Title 13, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application of a Federal Credit Union.)

By submitting this application, the Applicant(s) certify and agree: The lender or anyone authorized by the lender may obtain employment, credit, or other information relating to the Applicant(s) for this loan.