Please provide all of the requested information. When you have completed the form, press the "Submit Form" button to send your application to Georgia Federal Credit Union for processing. At that time, the data will be transferred on a Secure Server.

Account Number:
Credit Limit Requested:
Which type of credit are you applying for?
INDIVIDUAL CREDIT (Complete Applicant Section Only. Complete other section if the following applies: You live in a community property state (AZ, CA, ID, NM, P.R., TX, WA, WI) or you are relying on your spouse/Co-Applicant's income as a source of repayment.)
JOINT CREDIT (Provide information about both of you.)
APPLICANT
E-mail Address: SSN:
First Name: Date of Birth:
Mi: Driver's License No.:
Last Name:
Address: City:
State: Zip:
Phone Number:
Employer Name: Position:
Years in Line of Work: Gross Income:
Net Income: Years Employed:
Work Phone:
CO-APPLICANT
First Name: MI:
Last Name: SSN:
Date of Birth: Driver's License No.:
Address: City:
State: Zip:
Phone Number:
Employer Name: Position:
Years in Line of Work Gross Income
Net Income Years Employed
Work Phone
OTHER INCOME INFORMATION
Alimony, child support, or separate maintenance income need not be revealed if not considered as a basis for repaying this obligation.
Gross Monthly Wages Other Income (Describe)
Total Monthly Gross Income
FEDERAL EQUAL CREDIT OPPORTUNITY NOTICE
THE FEDERAL EQUAL CREDIT OPPORTUNITY ACT PROHIBITS CREDITORS FROM DISCRIMINATING AGAINST APPLICANTS ON THE BASIS OF SEX, MARITAL STATUS, RACE, AGE, COLOR, RELIGION, NATIONAL ORIGIN, RECEIPT OF PUBLIC ASSISTANCE, OR THE FACT THAT THE APPLICANT HAS EXERCISED RIGHTS UNDER THE CONSUMER CREDIT PROTECTION ACT. THE FEDERAL AGENCY WHICH ADMINISTERS COMPLIANCE WITH THE LAW CONCERNING THIS CREDIT UNION IS: THE NATIONAL CREDIT UNION ADMINISTRATION, SOUTHEASTERN REGIONAL OFFICE, 7000 CENTRAL PARKWAY, SUITE 1600 ATLANTA, GA 30328.
APPLICANT
Mortgage/Rent Monthly Payment
Balance Owed
CO-APPLICANT
Mortgage/Rent Monthly Payment
Balance Owed
VISA Card Disclosure
ANNUAL PERCENTAGE RATE
 (The same rate applies to Purchases and Cash Advances) 		Gold

12.84%		 Platinum

9.9%
ANNUAL MEMBERSHIP FEE NONE NONE
BALANCE TRANSFER FEE NONE NONE
GRACE PERIOD FOR PURCHASES 25 DAYS 25 DAYS
GRACE PERIOD FOR CASH ADVANCES NONE NONE
METHOD OF COMPUTING BALANCE Average Daily Balance
(Including New Purchases)		 Average Daily Balance
(Including New Purchases)
MINIMUM FINANCE CHARGE NONE NONE
TRANSACTION FEE FOR PURCHASES NONE NONE
CASH ADVANCE FEE NONE NONE
OVER-THE-LIMIT FEE $15.00 $15.00
LATE PAYMENT FEE $15.00 $15.00

I (we) hereby certify that all statements made are true and submitted for the purpose of obtaining credit from Georgia Federal Credit Union. In considering this application, GFCU may request and use a report from outside credit reporting agencies. I authorize GFCU to obtain additional credit reports in connection with the renewal or continuation of the credit for which I am applying or information on my spouse if I reside in a community property state. Upon request the Credit Union will supply the name and address of the credit reporting agency providing such information. I (we) have read and understand the disclosure. If this application is approved and a VISA card issued, I (we) agree by signing, using, or permitting another person to use the card(s) to be bound by the Cardholder Agreement and Disclosure accompanying the card(s).

By checking this box I hereby certify that I have read and understand the Cardholder Agreement/Disclosure and I submit this credit application for processing.