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SELCCU Visa Application

A table that includes required credit card disclosures is located here.  To obtain any change in the required information since it was posted to this Web site, write to us at:


SELCCU
c/o Visa Dept.
340 Griswold Road
Elyria, Ohio 44035
440-324-3400 / 800-451-6315



Before submitting this application, please review the Visa Terms & Conditions by clicking here

SELCCU Visa Application

Check below to indicate the type of credit for which you are applying. Married applicants may apply for a separate account.        
Joint Credit:
       
Guarantor:
       
Credit Limit Requested
       
Applicant
       
Name (Last - First - Initial)
       
Member Acct. #
       
Social Security Number
       
Driver's License Number / State
       
E-mail Address
       
Date of Birth (00/00/0000)
       
Home #
       
Work #/Ext.
       
Cell #
       
Present Address (Street - City - State - ZIP)
       
Own
       
Rent
       
Length at Residence
       
Mortgage/Rent Owed to:
       
Mortgage Balance
       
Monthly Payment
       
Complete for joint credit, secured credit or if you live in a community property state.        
Married
       
Separated
       
Unmarried (Single - Divorced - Widowed)
       
Name & Address of Employer
       
Start Date (00/0000)
       
Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.        
Employment Income
       
Frequency
       
Net
       
Gross
       
Other Income
       
Frequency
       
Source
       
Other
       
Name (Last - First - Initial)
       
Member Acct. #
       
Social Security Number
       
Driver's License Number / State
       
E-mail Address
       
Date of Birth (00/00/0000)
       
Home #
       
Work #/Ext.
       
Cell #
       
Present Address (Street - City - State - ZIP)
       
Own
       
Rent
       
Length at Residence
       
Mortgage/Rent Owed to:
       
Mortgage Balance
       
Monthly Payment
       
Interest Rate
       
Complete for joint credit, secured credit or if you live in a community property state.        
Married
       
Separated
       
Unmarried (Single - Divorced - Widowed)
       
Name & Address of Employer
       
Start Date (00/0000)
       
Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.        
Employment Income
       
Frequency
       
Gross
       
Net
       
Other Income
       
Frequency
       
Source
       
STATE LAW NOTICE - OHIO RESIDENTS ONLY
The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.        
STATE LAW NOTICE - WISCONSIN RESIDENTS ONLY
(1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened; (2) Please initial and date if you are NOT applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.        
Initials
       
Date
       
Acknowledgements
You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension, or collection of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state-chartered credit unions insured by NCUA.        
YOU UNDERSTAND THAT THE USE OF YOUR CARD WILL CONSTITUTE ACKNOWLEDGEMENT OF RECEIPT AND AGREEMENT TO THE TERMS OF THE CREDIT CARD AGREEMENT AND DISCLOSURES. YOU GRANT US A SECURITY INTEREST IN ALL INDIVIDUAL AND JOINT SHARE AND/OR DEPOSIT ACCOUNTS YOU HAVE WITH US NOW AND IN THE FUTURE TO SECURE YOUR CREDIT CARD ACCOUNT. WHEN YOU ARE IN DEFAULT, YOU AUTHORIZE US TO APPLY THE BALANCE IN THESE ACCOUNTS TO ANY AMOUNTS DUE. SHARES AND DEPOSITS IN AN INDIVIDUAL RETIREMENT ACCOUNT, AND ANY OTHER ACCOUNT THAT WOULD LOSE SPECIAL TAX TREATMENT UNDER STATE OR FEDERAL LAW IF GIVEN AS SECURITY, ARE NOT SUBJECT TO THE SECURITY INTEREST YOU HAVE GIVEN IN YOUR SHARES AND DEPOSITS.        
Applicant Initials
       
Date (00/00/0000)
       
Other Initials
       
Date (00/00/0000)
       

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