Visa Credit Card Application

All applicants must submit proof of income (a recent pay stub, tax returns or IRS form 1099) via Fax to: 714.894.1596.

*required fields

Individual Account
Joint Account with my spouse
Joint Account with someone other than my spouse or co-signer (send separate applicationsindicate this in the comment box at the end of this form)

Married applicants can apply for an individual account. Please indicate if you want an individual account in your name or a joint account with another person.

Notice: Applicant/Co-Applicant need not reveal income from alimony, child support or separate maintenance if such income is not to be considered as a basis for repaying the obligation.

Complete the co-applicant section if (1) this is to be a joint account with your spouse, (2) your spouse will use this account; (3) you live in a community property state (Arizona, California, Idaho, Louisiana, New Mexico, Nevada, Texas, Washington or Wisconsin); (4) you are relying on your spouses income in applying for this account; (5) your co-applicant is someone other than your spouse.


*Visa Type: *Limit Amount Applying For: $

Personal Information

Account Number:    
*First Name, MI: *Last Name:
*SSN: (123-45-6789) Marital Status:
*Drivers License #: *Birth Date: (27JUN1983)
Address: Address 2:
City: State:
Zip: At this address since: (08AUG2002)
Own  Rent  With Relatives  
Describe Other:
Rent or Mortgage: $
Home Phone Number: () *Email Address:
Work Phone Number: ()    
Cell Phone Number: ()
Previous Address (If at current address less than 2 years)
Address: Address 2:
City: State:
Zip: At this address since: (08AUG2002)

Employment Information

Employer: Retired
Address: Position:
City: State:
Zip: Employment Start Date: (08AUG1995)
Name of School:  For School District Employees:
*Gross Monthly Income:
12 months per year 10 months per year Additional Gross Monthly Income (2nd job, alimony, etc.)
Previous Employer (If at job less than 2 years)
Employer: Position:
    Employment Start Date: (08AUG1995)

2nd Employer: Employer Phone: () ext
Employment Start Date: (08AUG1995)

Nearest relative not living with you:

*Name: *Address:
*City: *State:
*Zip: *Home Phone: ()

Your Mother's Maiden Name: Depository Institution: Checking Account:
Depository Institution: Savings Account:

Co-applicant Information

Last Name: First Name, MI
SSN: - - Birth Date (27JUN1963)
Drivers License #: Relationship to Applicant: Spouse Other
(Skip the address information section if you are the spouse of the applicant.)
Address: Address 2:
City: State:
Zip:

Co-applicant Employer Information
Employer: Retired
Employer Address: Employer Address #2:
Employer City: Employer State:
Employer Zip: Employment Start Date: (08AUG1995)
Gross Monthly Income: $   12 months per year 10 months per year
Previous Employer (If at job less than 2 years)
Employer: Position:
    Employment Start Date: (08AUG1995)

Co-Applicant's nearest relative not living at the same address:

Name: Address:
City: State:
Zip: Home Phone: ()

Mother's Maiden Name: Depository Institution: Checking Account:
Depository Institution: Savings Account:

To which of our offices do you want your completed loan documents sent?

4341 East 10th St., Long Beach
4916 Bellflower Blvd., Lakewood
4436 Atlantic Ave, Bixby Knolls, Long Beach
11239 183rd St., Cerritos
6417 Spring St., Los Altos, Long Beach
1401 Quail St., Ste. 130, Newport Beach
Mail my loan documents to me

Other instructions and/or information:

 
Click here for LBS Financial Credit Unions Credit Card Solicitation Disclosure.
 
AGREEMENT
All the information in this application is true. I understand that section 1014 Title 18 U.S. Code makes it a federal crime to knowingly make a false statement on this application. You have my permission to verify any of this information. You may retain this application even if not approved. I understand that you may receive information from others about me or my accounts with you. If this application is approved, I understand and agree that using or retaining my Visa Cards or allowing others to do so constitutes my acceptance of the terms and conditions of the LBS Financial Credit Union Visa Credit Card Agreement and Disclosure Statement. I agree that my account shall be controlled by the terms and options I have selected on the reverse. I agree that the authorized use of my Visa Card shall constitute my receipt and acceptance of said Visa Credit Card Agreement and Disclosure Statement, which is incorporated by reference as if set forth here in full. I understand that you may share information concerning my credit experience with you and with others.

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