* = required fields
Name of Business   Achieva Member Number
*
*
Form of Ownership Years in Business  
*
*
 
Street Address    
*

City State Zip
*
*
*
Phone # Alt Phone # FEIN or SSN #
*
*
Business Activity Annual Gross Revenues* # of Employees
*
*
*
 
Name   Title
*
*
Desired Credit Limit Percent of Ownership  
$
*
%
*
 
Address    
*

City State Zip
*
*
*
Phone # Alt Phone # Social Security #
*
*
DL # State Issued DL Expiration Date
*
*
*
Date of Birth Annual Personal Gross Income* Achieva Member Number
*
*
*
 
Name   Title
Desired Credit Limit Percent of Ownership  
$
%
 
Address    

City State Zip
Phone # Alt Phone # Social Security #
DL # State Issued DL Expiration Date
Date of Birth Annual Personal Gross Income* Achieva Member Number
 
Name   Authorized Credit Limit
$
Address    

City State Zip
Phone # Social Security # Date of Birth
 
Name   Authorized Credit Limit
$
Address    

City State Zip
Phone # Social Security # Date of Birth
 

For additional cards, please provide a written request signed by owner/official signer including personal information on the authorized users and include with this application.

NOTICE TO GUARANTOR
You are being asked to guarantee the debt on this account for the borrower(s). Think carefully before you do because you will also guarantee any future increase request on this account made by the borrower(s). Be sure you are able to afford this debt now and in the future since you will be responsible to pay it in its entirety if the borrower(s) default on payments. In addition, you may also have to pay late fees or collection costs, which will increase the balance of the debt. The credit union has the same right to collect on this debt from you that it has on the borrower(s) and the same collection methods used against the borrower(s) will apply to you. This may include garnishing your wages and/or filing claims against you. We may also report negative information about this account against you to credit reporting agencies, including a failure to pay the debt on time (late payments, missed payments or other defaults).

Fact Act Notice - We may furnish information about this account to credit reporting agencies. Late or missed payments or other defaults on this account could be reflected in your credit report.

     
Principal/Owner for Applicant and Individually as guarantor
Name Title Date
*
*
*
Principal/Owner for Applicant and Individually as guarantor
Name Title Date
Principal/Owner for Applicant and Individually as guarantor
Name Title Date
   

*Income from alimony, child support, and separate maintenance, does not need to be revealed unless you want it considered as a basis for repaying this obligation.