2urchases 16.90% Fixed   16.90% Fixed   16.90% Fixed   None   rchases Your due date is at least 25 days after the close of each billing cycle. We will not charge you interest on purchases if you pay your entire balance by the due date (Grace Period) each month.   if you are charged interest, the charge will be no less than $0.00   ‘al Reserve Board   To learn more about factors to consider when applying for or using a credit card, visit the web site of the Federal Reserve Board at http:/www.federalreserve.gov/creditcard.    $10.00   None None None   lf the minimum required payment is not received within 10 days after the closing date subsequent to the payment due date, a late payment fee of 5.0% will be imposed. None None       None       a method called “average daily balance” (including new purchases).* An explanation of this method is provided in your account agreement. jute transactions and how to exercise those rights Is provided in your account agreement. ¥     Check Account Choice: (Signature required ep applicant) Visa CREDIT APPLICATION Credit Limit Requested $   (1 Individual Account J Joint Account (see co-applicant and signatures section) J Credit Line Increase     IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, Federal laws require all financial      information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. ions to obtain, verify and record information that identifies each person who opens an Account, What this means to you: When you open an Account, we will ask for your name, address, date of birth, and other              Last Name First Middle Social Security Number   Home Phone Cell Phone i 4 { ) Date of Birth No. of Dependents     Own Rent Other ‘i = a) Monthly Payment $   Current Address City State Zip Code How Long (yrs)   Mailing Address (if different from above) City State Zip Code How Long (yrs)   Previous Address (if less than 2 years at present address) City   State Zip Code   How Lang (yrs)   Employer Self Employed Yes No   Work Phone { ) Date Employed   LNVOIIdd¥ Address   Position/Qccupation Monthly Gross Income $   voyeodde mod Gurssadoud we Agen prone of Name and Address of Previous Employer (if less than 2 years at present employer) How Long (yrs)   Aapadwes jo papy sq pindus suOEoas ajaetidde jpy -ayoy Source of Additional Income: Income from alimony, child support or separate maintenance need not be revealed if it is not considered in determining creditworthiness Amount per Month $   Nearest Relative (Not Living With You) Home Phone { ) Relationship   = Last Name First Middle Social Secunty Number   Date of Birth Hame Phone Cell Phone (  ) { ) No. of Dependents WE JOY     Own = Rent Other 4 4 ia Monthly Payment $   Current Address : City y pauinh State Zip Code How Lang {yrs}   Previous Address (if less than 2 years at present address) City   “UNIIIE [ENPIAIPUE State Zip Code   How Lang (yrs)   Siu) ueadde juiol Jo) papuayuy’ INVOMTdd¥-09 a) JOU Si UOREUUO YUL Self Employed Yes No Employer   Work Phone ( ) Date Employed   Address     PositionOccupation Monthly Gross Income $   Name and Address of Creditor Name under Which Account is Carried Account Number Balance Monthly Payment   1, Home Mortgage/Rent   2. Bank Credit Card/Bank Name and Address Aiesseoan || Se2uS feuomippy ypetty   OANI LIGSY9D             time. We may report information about your account to the credit bureaus. Late payments, missed pay Xx x Applicant Signature Date Co-           _ Credit Card Account Number   Signature   licant Signature     PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING: This statement is submitted to obtain credit and I/we certify that all information herein is true and complete. I/We agree that inquiries may be made to verify information and that credit references or verification may be given based on inquiries from other parties. This offer is subject to the credit policies of this institution. We agree to be bound by the terms and conditions of the cardholder agreement, a copy of which will be mailed to the applicant if this application is granted, receipt of such agreement and acceptance of such terms to be conclusively presumed by the applicant's use. If you intend to apply for joint credit, the undersigned shall be jointly and severally liable for any and all credit extended from time to ts, or other defaults on your account may be reflected in your credit report.     Amount to be transferred $ Upon approval, | wish to transfer my present balance on the credit card accounts} listed below to my new credit card account. Date     Visa Account No.   Credit Line SSYNLWNOIS} W830 |IVNYSLNI MAdSNVUL} =O LS3NOFY JAINO ASN Date Approved       Approved By     Cache Valley Bank, Logan, UT 84323-3227 FOLD AND SECURE WITH TAPE FOR MAILING All contents are accutate at the time of printing, for changes thet may have been made after printing please call (435) 753-3020. Application ©2009 FIS* 05/10