I designate the following as Authorized User(s) on my Signature Federal Credit Union Visa Credit Card. I hereby certify that I will be solely responsible for all card usage by the Authorized User(s). The credit card and monthly statements will be sent to the address that I have on file with my current Visa Credit Card.

Authorized Users are as Follows

Name	DOB	SSN
User Name 1	Date and time	User SSN 1
User Name 2	Date and time	User SSN 2
User Name 3	Date and time	User SSN 3
User Name 4	Date and time	User SSN 4
User Name 5	Date and time	User SSN 5
User Name 6	Date and time	User SSN 6

Signatory Authorization and Agreement

Signature		Date
		Date and time
Member Number	VISA Card Number	Daytime Phone
Prove you're not a robot*