VISA Application



You must check this box in order to submit the application. By checking the box, you agree to the waiver below:

WAIVER: I understand that by sending this form over the Internet that my personal information may not be secure and I release our Credit Union and all its officials, employees, affiliates, subsidiaries, vendors, and assignees from any liability and/or loss that arises from using this form.

Note: If you feel more comfortable, you can print this form, fill it out and drop it off at any CHACO location or you can mail it to CHACO Credit Union, Attn: Lending Department, 100 South Third Street, Hamilton, OH 45011. If you choose either of these options, your signature must appear somewhere on this application.
 
Loan Request Information:
* Email:
* Requested Credit Line: $
* Type of Card:
Applicant Information:
*Member Account Number:
* Social Security Number:
* Full Name:
* Residential Street Address: Street: Apt:
* City:
* State:
* Zip:
* Do You: Own Rent
* How long have you lived at this address? Years Months
* Monthly rent or mortgage payment? $
* Home Phone Number:
Work Phone Number:
* Date of Birth:
* Number of Dependents:
Marital Status (If you live in a community property state): Married Unmarried Separated
Previous Address (if at current address less than 2 years): Street: Apt:
City:
State:
Zip:
Employment Information:
* Name of Employer:
* Employer's Address:
* City:
* State:
* Zip:
* Gross Monthly Salary: $
* Length of Employment: Years Months
Position or Job Title:
Please list any other income. You need not list income from Alimony, Child Support, or Separate Maintenance unless you wish it considered for purposes of granting this credit. Include the source and the monthly dollar amount:
Co-Applicant Information:
Complete this section only for: (i) joint credit; (ii) with spousal information if your spouse will use or be liable on the account, you will rely on your spouse's income to pay the debt or if you reside in a community property state.
Co-applicant's Name:
Co-applicant's Social Security Number:
Your relationship to Co-applicant:
Name of Employer:
Employer's Address:
City:
State:
Zip:
Gross Monthly Salary: $
Length of Employment: Years Months
Position or Job Title:
By signing this Application, or by submitting it on-line to Chaco Credit Union, you are authorizing the Credit Union to review your credit history and report through a credit reporting agency.

Special Note: Verification of income and other supporting documentation may be required to complete the processing of this loan application.