Student Secured VISA Application

Please read over the Consumer Credit Card Agreement.

Agreement








 






 




IF less than 1 year at current address



 



Marital Status

Married
Single
Divorced
 




Pay Frequency

Weekly
Bi-Weekly
Semi-Mo.
Monthly
 





Reference






 



Other Information About You
Applicant

Yes
No
 
If you answer "Yes" to any question other than #1, explain below.
Are You A U.S. Citizen or Permanent Alien?

Yes
No
 
DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGEMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT PLAN CONFIRMED UNDER CHAPTER 13, HAD PROPERTY FORE CLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS, OR BEEN A PARTY IN A LAWSUIT?

Yes
No
 

Savings Secured Credit Card Pledge
Savings Pledge
Signature(s)
Signature


VISA Account Updater
VISA Updater OPT OUT
Security
  captcha code for visual authentication  letter H number 5 letter U number 8