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                                                             Visa   Credit Card 
                                                                   APPLICATION 
    Card Type Applying For:     A table that includes required credit card disclosures is on a separate document provided with this application. To 
             D  Off Platinum  D  Off Platinum Rewards  D  Off Cash Rewards  obtain any change in the required information since it was printed, call us toll-free at 800-268-6928 or write to us 
                                at the address stated on this application. 
    Check below to indicate the type of credit for which you are applying. Married applicants may apply for a separate account. 
    D  Off    Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if: 
     1. you live in a Community Property State (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI); 
     2. your spouse will use the account; or 
     3. you are relying on your spouse�s income as a basis for repayment. If you are relying on income from alimony, child support or separate maintenance, 
      complete the Other section to the extent possible about the person on whose payments you are relying. 
    D  Off      Joint Credit: Each applicant must individually complete the appropriate section below. If co-borrower is spouse of the applicant, mark the 
     co-applicant box. 
   APPLICANT                                OTHER                                 D  Off    CO-APPLICANT  D  Off SPOUSE 
                                           1=1 
   Complete for Joint Credit, Secured Credit or if you live in a Community Property State: Complete for Joint Credit, Secured Credit or if you live in a Community Property State:
   D  Off  Married  D  Off Separated  D  Off Unmarried (single, divorced, widowed)  D  Off  Married  D  Off Separated  D  Off Unmarried (single, divorced, widowed) 
   Name (Last - First - Initial)            Name (Last - First - Initial) 
   Account Number      Social Security Number  Account Number   Social Security Number 
   Driver�s License Number/State  Email Address  Driver�s License Number/State  Email Address 
   Phone  D  Off        Mobile  D  Off Home  D  Off Work  D  Off Mobile  D  Off Home  D  Off Work  Birth Date  Phone  D  Off        Mobile  D  Off Home  D  Off Work  D  Off Mobile  D  Off Home  D  Off Work  Birth Date 
   Present Address (Street - City - State - Zip)   D  Off  Own  D  Off Rent  Present Address (Street - City - State - Zip)   D  Off  Own  D  Off Rent 
                       Length at Residence                      Length at Residence 
   Mortgage/Rent Owed to:                   Mortgage/Rent Owed to: 
   Mortgage Balance    Monthly Payment  Interest Rate Mortgage Balance  Monthly Payment  Interest Rate
   $                   $                %   $                   $                 % 
   EMPLOYMENT/INCOME                        EMPLOYMENT/INCOME 
   Name and Address of Employer             Name and Address of Employer 
                              Start Date_____________________       Start Date____________________ 
   NOTICE: Alimony, child support or separate maintenance income need not be revealed if  NOTICE: Alimony, child support or separate maintenance income need not be revealed if 
   you do not choose to have it considered.  you do not choose to have it considered. 
   Employment Income   Other Income         Employment Income   Other Income 
   $__________________ Per_______________ $__________________ Per_______________  $__________________ Per_______________ $__________________ Per_______________ 
   D  Off  Net  D  Off Gross  Source________________________________  D  Off  Net  D  Off Gross  Source________________________________ 
   State Law Notices                       affect the rights of the Credit Union unless the Credit Union is furnished a copy of the
   Ohio Residents Only: The Ohio laws against discrimination require that creditors make  agreement, statement or decree or has actual knowledge of its terms, before the credit is
   credit equally available to all creditworthy customers, and that credit reporting agencies  granted or the account is opened. (2) Please sign if you are not applying for this account or
   maintain separate credit histories on each individual upon request. The Ohio Civil Rights  loan with your spouse. The credit applied for, if granted, will be incurred in the interest of 
   Commission administers compliance with this law.  the marriage or family of the undersigned.
   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  X_______________________________________________  Date________________________
                                               SIGNATURE FOR WISCONSIN RESIDENTS ONLY 
                                      SIGNATURES 
   1. You promise that everything you have stated in this application is correct to the best  2. You understand that the use of your card will constitute acknowledgment of receipt 
   of your knowledge. If there are any important changes, you will notify us in writing  and agreement to the terms of the credit card agreement and disclosures. You grant us 
   immediately. You authorize the Credit Union to obtain credit reports in connection with this  a security interest in all individual and joint share and/or deposit accounts you have with 
   application for credit and for any update, increase, renewal, extension or collection of the  us now and in the future to secure your credit card account. When you are in default, 
   credit received. You understand that the Credit Union will rely on the information in this  you authorize us to apply the balance in these accounts to any amounts due. Shares and 
   application and your credit report to make its decision. If you request, the Credit Union will  deposits in an Individual Retirement Account, and any other account that would lose 
   tell you the name and address of any credit bureau from which it received a credit report  special tax treatment under state or federal law if given as security, are not subject to the 
   on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect  security interest you have given in your shares and deposits. 
   information on loan applications made to federal credit unions or state-chartered credit 
   unions insured by NCUA. 
   X______________________________________________  ___________________________ (SEAL)  X______________________________________________  ___________________________ (SEAL) 
        APPLICANT�S SIGNATURE   DATE            OTHER SIGNATURE       DATE 
                                   CREDIT UNION USE ONLY 
              D  Off   Approved  Beacon______ No. of Cards______ Credit Limit $_______________ Credit Card Number_______________________ 
              D  Off    Declined  Credit Committee or Loan Officer Signature________________________________________________________________ 
              Comments/Counter Offer____________________________________________________________________________________________ 
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                                                             Visa   Credit Card 
                                  APPLICATION AND SOLICITATION DISCLOSURE 
       Interest Rates and Interest Charges 
       Annual Percentage Rate (APR)  Visa Platinum 
       for Purchases 
                           0% Introductory APR for a period of twelve (12) billing cycles.   
                           After that your APR will be 
                           9.90%, 11.90%, 14.90% or 18.90%, based on your creditworthiness.    
                           This APR will vary with the market based on the Prime Rate. 
                           Visa Platinum Rewards 
                           0% Introductory APR for a period of twelve (12) billing cycles.    
                           After that your APR will be 
                           10.90%, 12.90%, 15.90% or 19.90%, based on your creditworthiness.    
                           This APR will vary with the market based on the Prime Rate. 
                           Visa Cash Rewards 
                           0% Introductory APR for a period of 12 billing cycles. 
                           After that your APR will be 
                           11.90%, 13.90%, 16.90% or 20.90%, based on your creditworthiness.  
                           This APR will vary with the market based on the Prime Rate. 
       APR for Cash Advances  Visa Platinum 
                           0% Introductory APR for a period of twelve (12) billing cycles. 
                           After that your APR will be 9.90%, 11.90%, 14.90% or 18.90%, based on your 
                           creditworthiness. This APR will vary with the market based on the Prime Rate. 
                           Visa Platinum Rewards 
                           0% Introductory APR for a period of twelve (12) billing cycles. 
                           After that your APR will be 10.90%, 12.90%, 15.90% or 19.90%, based on your 
                           creditworthiness. This APR will vary with the market based on the Prime Rate. 
                           Visa Cash Rewards 
                           0% Introductory APR for a period of 12 billing cycles. 
                           After that your APR will be 11.90%, 13.90%, 16.90% or 20.90%, based on your 
                           creditworthiness. This APR will vary with the market based on the Prime Rate. 
       APR for Balance Transfers  Visa Platinum 
                           0% Introductory APR for a period of twelve (12) billing cycles. 
                           After that your APR will be 9.90%, 11.90%, 14.90% or 18.90%, based on your 
                           creditworthiness. This APR will vary with the market based on the Prime Rate. 
                           Visa Platinum Rewards 
                           0% Introductory APR for a period of twelve (12) billing cycles. 
                           After that your APR will be 10.90%, 12.90%, 15.90% or 19.90%, based on your 
                           creditworthiness. This APR will vary with the market based on the Prime Rate. 
                           Visa Cash Rewards 
                           0% Introductory APR for a period of 12 billing cycles.   
                           After that your APR will be 11.90%, 13.90%, 16.90% or 20.90%, based on your 
                           creditworthiness. This APR will vary with the market based on the Prime Rate. 
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                                                             Visa   Credit Card 
                                  APPLICATION AND SOLICITATION DISCLOSURE 
       Interest Rates and Interest Charges 
       Penalty APR and        Visa Platinum 
       When It Applies        21.90%   
                              This APR will vary with the market based on the Prime Rate. 
                              Visa Platinum Rewards 
                              22.90% 
                              This APR will vary with the market based on the Prime Rate. 
                              Visa Cash Rewards 
                              23.90% 
                              This APR will vary with the market based on the Prime Rate. 
                              This APR may be applied to the entire balance on your account if you: 
                              � Make a late payment 
                              How long will the penalty APR apply? If your APRs are increased for this reason, 
                              the penalty APR will apply until you make at least six (6) consecutive minimum 
                              payments when due. 
       How to Avoid Paying Interest   Your due date is at least 25 days after the close of each billing cycle. We will not  
       on Purchases           charge you any interest on purchases if you pay your entire balance by the due date 
                              each month. 
       Minimum Interest Charge  None 
       For Credit Card Tips From  To learn more about factors to consider when applying for or using a 
       the Consumer Financial  credit card, visit the website of the Consumer Financial Protection Bureau 
       Protection Bureau      at http://www.consumerfinance.gov/learnmore. 
       Fees 
       Set-up and Maintenance Fees 
       � Annual Fee           None 
       � Account Set-up Fee   None 
       � Program Fee          None 
       � Participation Fee    None 
       � Additional Card Fee  None 
       � Application Fee      None 
       Transaction Fees  
       � Balance Transfer Fee     2% or $10.00, whichever is greater 
       � Cash Advance/ATM Fee   2% or $10.00, whichever is greater 
       � Foreign Transaction Fee    1% of each transaction in U.S. dollars 
       � Transaction Fee for Purchases  None 
       Penalty Fees 
       � Late Payment Fee     Up to $37.00 
       � Over-the-Credit-Limit Fee     $25.00 
       � Returned Payment Fee  $25.00 
       How We Will Calculate Your Balance: We use a method called �average daily balance (including new purchases).�  
       Loss of Introductory APR: We may end your Introductory APR for purchases, balance transfers and cash advances and   
       apply the penalty APR if you are 60 days late in making a payment. 
       Application of Penalty APR: Your APR may be increased to the disclosed penalty APR if you are 60 days late in making 
       a payment or make a payment that is returned. 
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                                                             Visa   Credit Card 
                                  APPLICATION AND SOLICITATION DISCLOSURE 
        Effective Date 
        The information about the costs of the card described in this application is accurate as of November 3, 2018.   
        This information may have changed after that date. To find out what may have changed, contact the Credit Union. 
        For California Borrowers, the Visa Platinum, Visa Platinum Rewards and Visa Cash Rewards are secured credit 
        cards. Credit extended under this credit card account is secured by various personal property and money 
        including, but not limited to: (a) any goods you purchase with this account, (b) any shares you specifically pledge 
        as collateral for this account on a separate Pledge of Shares, (c) all shares you have in any individual or joint 
        account with the Credit Union excluding shares in an Individual Retirement Account or in any other account that 
        would lose special tax treatment under state or federal law, and (d) collateral securing other loans you have with 
        the Credit Union excluding dwellings. Notwithstanding the foregoing, you acknowledge and agree that during 
        any periods when you are a covered borrower under the Military Lending Act your credit card will be secured 
        by any specific Pledge of Shares you grant us but will not be secured by all shares you have in any individual or 
        joint account with the Credit Union. For clarity, you will not be deemed a covered borrower if: (i) you establish 
        your credit card account when you are not a covered borrower; or (ii) you cease to be a covered borrower. 
        Other Disclosures 
        Late Payment Fee         $37.00 or the amount of the required minimum payment, whichever is less. 
        Over-the-Credit-Limit Fee        $25.00 
        Returned Payment Fee       $25.00 or the amount of the required minimum payment, whichever is less. 
        Statement Copy Fee         $5.00 
        Document Copy Fee         $5.00 
        Rush Fee                 $30.00 
        Emergency Card Replacement Fee       $30.00 
        PIN Replacement Fee         None 
        Card Replacement Fee       $10.00 
        Unreturned Card Fee         None 
        Stop Payment for Convenience Check Fee       $20.00 
                                                    Please complete and fax or mail the application to: 
     Inter-office Mail                            Dominion Energy Credit Union � One James River Plaza 
     15th Floor, VA-OJRP                                  P.O. Box 26646, Richmond, VA 23261-6646 
                                                                      Fax to 804.771.3768 
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