VyStar Credit Union
BUSINESS CREDIT CARD APPLICATION
Please choose the Visa® product that best fits your business needs.
Micro Business Platinum Visa®
Designed for newer businesses. Credit limits
between $500 and $2,500. Great Visa benefits.
No personal or business tax returns required
for approval.
Tell Us About Your Business
Street (no P.O. Box)
)
Business Email:
Business Member #:
City
Mailing Address: (if different from above)
Business Phone: (
Credit limits available between $5,000 and $50,000.
Personal and business tax returns may be required
for approval. Includes a UChoose Rewards®
points-earning program and Visa benefits.
Credit limits available between $2,500 and
$25,000. Must be secured by a VyStar CD
or Savings Account. Great Visa benefits.
Legal Business Name:
Physical Business Address:
Business Platinum Rewards Visa®
Business Secured Platinum Visa®
Business Fax: (
Business Tax ID #:
)
Other Phone: (
Business Website:
Month/Year Business Started:
Number of Employees:
/
Annual Business Profit: $
Industry/Business Type: Manufacturer Wholesaler Retail
Nature of Business/Service Provided:
Service
State
Zip
)
Business Annual Sales: $
Business Franchise:
Yes
No
Professional Other:
Legal Business Structure: Sole Proprietorship Corporation Partnership Limited Liability Co. Organization Other:
Purpose for Card:
Business Credit Limit Requested: $
List All Individual Cardholders (i.e. Authorized Users)
Authorized User #1:
Address:
SSN:
last name
Street (no P.O. Box)
Authorized User #2:
Address:
SSN:
To Whom Payable
Phone: (
last name
Street (no P.O. Box)
Financial Institution Name
first name
middle initial
City
)
first name
Phone: (
middle initial
City
)
Driver’s Lic #:
Date of Birth:
State
Credit Limit $:
% of Ownership:
Driver’s Lic #:
Date of Birth:
State
Credit Limit $:
% of Ownership:
Cur rent Business Checking/Savings Account(s) (attach additional sheets if necessary)
Opening Date
Account Type
Account #
Cur rent Business Loans and Indebtedness (attach additional sheets if necessary)
Original
Amount $
Original
Date
Current
Balance $
Monthly
Payment $
Zip
Interest
Rate %
Maturity
Date
Zip
Balance $
Collateral
Pledged
(continued on back side)
(Continued) VyStar Credit Union BUSINESS Credit Card • APPLICATION
Ownership/Management Infor mation
1. Do you understand that your personal credit history will be reviewed as part of this application?
Yes
2. Have you been denied credit by VyStar Credit Union within the last 6 months?
Yes*
3. Have any owners, managers, guarantors, officers presently been charged under indictment, on parole or on parole?
Yes*
4. Have any of the above ever been charged with, or arrested for, any criminal offense other than minor motor vehicle violation?
Yes*
5. Have any of the above listed ever been convicted of any criminal offense other than a minor motor vehicle violation?
Yes*
6. Has your business, or have any principals of the business, been involved in a bankruptcy or insolvency proceeding?
Yes*
7. Is your business, or are any of the principals of the business, currently involved in any pending judgements, claims, or lawsuits?
*If you answered YES to any of questions 2 - 7 above, please furnish details on a separate sheet.
Yes*
No
No
No
No
No
No
No
Authorized Signatures and Disclosures (owners of 25% or more must sign below)
The undersigned principal(s) certify that he/she has full authority to act on behalf of the applicant and to designate authorized users. Upon approval of my/our VyStar
Business VISA Credit Card (Card), I/we agree to the terms and conditions and disclosures that will be mailed both before and with my/our new Card(s). I/We further represent that the Cards issued will be used solely for business purposes, including commercial, industrial and professional purposes, and NOT for personal,
family or household purposes. I/We authorize VyStar Credit Union to check my/our credit and employment history or verify any other information provided. The
undersigned acknowledge that all and any supporting documentation will remain the property of VyStar Credit Union, and that all information on or presented with
this application, including any financial statements and/or tax returns, are complete, true and accurate.
X
Owner [Print Name]
Signature
Title / % Ownership
Date
X
Owner [Print Name]
Signature
Title / % Ownership
Date
Personal Guarantee(s) (owners of 25% or more must sign below)
By signing below, I/we hereby absolutely and unconditionally guaranty prompt payment when due and at all times thereafter of any and all existing and future indebtedness
and liabilities of every nature and kind, including all renewals, extensions and modifications thereof, now or hereafter. I/We waive notice of the acceptance of this Guaranty
and of all extensions of credit hereafter. I/We further waive presentment, protest, notice, demand, or action of any nature on any delinquency with respect to the indebtedness, including the right to require the creditor to sue or otherwise enforce payment thereof, or to enforce any other security or guaranty given therefore. I/We agree that this
guaranty will remain in force until the Agreement has terminated and all amounts due thereunder shall have been paid in full. I/We agree to and authorize VyStar Credit Union
to verify or obtain further information as it may deem necessary concerning the identity or credit worthiness of the individuals below, including through the use of reports
obtained from consumer reporting agencies. I/We further certify that all information on or presented with this application, including any financial statements and/or tax returns,
are complete, true and accurate.
X
Print Guarantor Name
Guarantor Signature
Guarantor Social Security Number
Date
X
Print Guarantor Name
Guarantor Signature
Guarantor Social Security Number
Date
This Section for Business Secured Platinum Visa® Only (if secured, owners of 25% or more must sign below)
I/We hereby grant VyStar Credit Union a security interest in the below listed account as a condition of establishing a Business Secured Platinum VISA. I/We promise to maintain the balance of said account at or above the approved credit limit, and for as long as the credit limit remains in effect. We further authorize
VyStar Credit Union to restrict the pledged amount, and understand that VyStar Credit Union may hold said funds for up to thirty (30) days after revocation,
expiration or voluntary cancellation of this credit facility to allow any outstanding charges to clear the account.
Account # :
Signature:
Date:
Signature:
Date:
Please provide the following supporting information with this application:
• Micro Business Platinum and Business Secured Platinum: Only this application
• Business Platinum Rewards
– Limits of $10,000 and below: Only this application (some cases may require one-year Business (if not
a sole-proprietor) and Personal Tax Returns (all schedules)
– Limits of $10,001 - $25,000: Most recent Business (if not a sole-proprietor) and Personal Tax Returns
(all schedules)
– Limits of $25,001 - $50,000: Most recent two-years Business (if not a sole-proprietor) and Personal Tax
Returns (all schedules)
OFFICIAL USE ONLY:
Branch #
Teller ID #
VyStar Credit Union Business Services Department
P.O. Box 45085 • Jacksonville, FL 32232-5085
(904) 908-2292 or 1-800-445-6289, extension 2292
Rev 1/13