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Credit Card Form


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IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, Federal laws require all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means to you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.


All applicable sections should be filled out completely to avoid delay in processing your application.



Physical Address (P.O. boxes not allowed)


Mailing Address





Physical Address (P.O. boxes not allowed)



Interest Rates and Interest Charges Visaź
Annual Percentage Rate (APR) for Purchases 16.80%
APR for Balance Transfers 16.80%
APR for Cash Advances 16.80%
Penalty APR and When it Applies None
How to Avoid Paying Interest on Purchases Your due date is not less than 25 days after the close of each billing cycle. We will not Charge you interest on purchases if you pay your entire balance by the due date (Grace Period) each month.
Minimum Interest Charge None
For Credit Card Tips from the Federal Reserve Board To learn about factors to consider when applying for or using a credit card, visit the website of the Federal Reserve Board at
Fees Visaź
Annual Fee None
Membership Fee None

Transaction Fees

  • Balance Transfer
  • Cash Advances
  • Foreign Transaction





Penalty Fees

  • Late Payment
  • Over-the-Credit-Limit
  • Returned Payment




Other Fees None

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SUBMITTING: 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 verifcation may be given based on inquiries from other parties. This offer is subject to the credit policies of the institution. I/We agree to be bound by the terms and conditions of the cardholder agreement, a copy of which will be mailed to the borrower if this application is granted, receipt of such agreement and acceptance of such terms to be conclusively presumed by the borrower's use. If you intend to apply for joint credit, the undersigned shall be jointly and severally liable for any and all credit extended from time to time. We may report information about your account to the credit bureaus. Late payments, missed payments, or other defaults on your account may be reflected in your credit report.