Total Visa

Edit Your Information

Click on one of the card images below to select your FREE design:

*required fields

First Name*

Last Name*

Suffix

Email Address*

Verify Email Address*

Street Address Line 1*

Address Line 2/Apt

City*

State*

Zip Code*

Mailing Address

Mailing City *

Mailing State *

Mailing Zip Code *

Home Phone Number *

Minimum one phone number required. Minimum one phone number required.

Mobile Phone Number *

Do you have an active checking account?*

Yes No

Date of Birth *

You must be 18 yrs or older to be eligible.

Social Security Number *

Verify Social Security Number *

Employment Status *

Employer Name

Employer Phone

You need not reveal alimony, child support or separate maintenance income if you do not wish to have them considered as a basis for repaying this obligation.

Net Monthly
Income *

(commonly referred to as take home pay)

Estimated Monthly
Expenses *

(rent/mortgage, utilities, other regular expenses and debt payments)

Do you have/use a debit or credit card?*

Yes No

Do you intend to use the card for cash advances? *

Yes No

Would you like to add an additional cardholder? *

Yes No

First Name

Last Name

Enter an Additional Cardholder (must be different from the primary Applicant). Note that a $29 Additional Card Fee will apply annually and will be assessed to your account prior to issuing your card. The fee will reduce the initial available credit on your account; based on an initial credit limit of $300, the initial available credit will be $196. Note that credit bureau reporting and liability for repayment will remain in the name of the primary applicant, and the second card will not be sent to you until you have paid the Program Fee.