Richmond Community Federal Credit Union

VISA® APPLICATION

Card Choice: VISA

Account Choice: Individual Account Joint Account

APPLICANT Note: All Applicable Sections Should Be Filled out Completely. If Not processing Of Your Application May Be Delayed

Last Name		First	Middle
Date of Birth	No. of Dependents	Home Phone	Own Rent Other
Current Address		City	State Zip Code
Employer		Self Employed Yes No	Work Phone
Address		Position/Occupation

CO-APPLICANT or SPOUSE Complete This Section Only If CO-Applicant or Spouse is Applying For Joint Account

Last Name		First	Middle
Date of Birth	No. of Dependents	Home Phone	Own Rent Other
Current Address		City	State Zip Code
Employer		Self Employed Yes No	Work Phone
Address		Position/Occupation

*You Need Not Furnish Alimony, Child Support or Maintenance Income Information If You Do Not Want Us To Consider It In Evaluating Your Application

CREDIT DISCLOSURES

ANNUAL PERCENTAGE RATE FOR PURCHASES	ANNUAL MEMBERSHIP FEE	GRACE PERIOD FOR PURCHASES	METHOD OF COMPUTING THE BALANCE FOR PURCHASES	LATE PAYMENT FEE	OVER THE LIMIT FEE	CASH ADVANCE FEE
6.9% - 17.9%	NONE	25 DAYS	AVERAGE DAILY BALANCE INCLUDING NEW PURCHASES	$20.00	$20.00	NONE
At the date this application was printed (shown in the lower right-had corner-this side) the information listed above was accurate. Because rates and terms are subject to change, you may contact us for the current information by writing to the business reply address shown on the reverse side.
A finance charge will be imposed on Credit Purchases only if you elect not to pay the entire New Balance shown on your monthly statement for the previous billing cycle within 25 days from the closing date of that statement. If you elect to pay the entire New Balance shown on your previous monthly statement within that 25-day period, a Finance Charge will be imposed on the unpaid average daily balance of such Credit Purchases from the previous statement closing date and on new Credit Purchases from the date of posting to your account during the current billing cycle, and will continue to accrue until the closing date of the billing cycle preceding the date on which the entire New balance is paid in full or until the date of payment if more than 25 days from the closing date. The Finance Charge for a billing cycle is computed by applying the monthly Periodic Rate to the average daily balance of Credit Purchases, which is determined by dividing the sum of the daily balances during the billing cycle by the number of days in the cycle. Each daily balance of Credit Purchases is determined by adding the outstanding unpaid balance of Credit Purchases at the beginning of the billing cycle to any new Credit Purchases posted to your account, and subtracting any payments as received and credits as posted to your account, but excluding any unpaid Finance Charges. A finance charge will be assessed on cash advances from the date of the cash advance, or the first day of the billing cycle in which the cash advance is posted, whichever is later, and will continue to accrue until payment in full is made. Cash Advances will be calculated in the same manner as explained for Credit Purchases.

SIGNATURE(S)

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 credit policies of this institution. I/We agree to be bound by the terms and conditions of the bank card 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 this is a joint application, the undersigned shall be jointly and severally liable for any and all credit extended from time to time. You agree that if you are approved for the VISA, you will give Richmond Community Federal Credit Union the following security interest to secure the payment of any credit extended on the account. You agree that in the event of your default, we may apply the amount of any monies you may have on deposit to the outstanding balance. Our interest in shares or deposits at the time of default is the result of your general pledge of shares. You agree that this security interest becomes part of the "VISA Agreement & Disclosure" which will accompany the card, and you acknowledge this pledge by your signature below.

X__________________________________________
APPLICANT SIGNATURE DATE

X__________________________________________
CO-APPLICANT SIGNATURE DATE

SIGNATURE(S) TO OBTAIN INSURANCE

YES

Please enroll me in the optional MEMBER'S CHOICE insurance program. I have read and understood the insurance and cost disclosures as described herein. MEMBER'S CHOICE costs vary by state but won't exceed 70 per$100 of my monthly balance. The cost will be charged to my account each month. This insurance is voluntary & I may cancel at any time.

X__________________________________________
(primary/first-named applicant)

X__________________________________________
(eligible to age 70)

FOR INTERNAL USE ONLY

VISA Account No.			Gold VISA Account No.
DATE APPROVED	CREDIT LINE	APPROVED BY	DATE APPROVED	CREDIT LINE	APPROVED BY

You Must Print, Sign, and Return to Credit Union
(by mail, fax, or in person)
A signature is needed to complete the process

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