CREDIT CARD APPLICATION 
  Visit uiccu.org for a complete list of card benefits. 

 Platinum Rewards MasterCard 

Earn points each time you use our Platinum Rewards MasterCard.  You can redeem those points for cash, travel, 
merchandise,  event        tickets  and  much  more.  You’ll  earn  at  least  one  point  for  each  dollar  of  purchase,  or 
considerably more if shopping with a merchant on  our Rewards Plus list. And don’t forget the 1,000 bonus points 
you  get  with  your  first  purchase.    It  also  features  an  introductory  rate  of  0%  APR  for  the  first  6  months.    Visit 
www.selectyourrewards.com/UICCU and select "browse only" for details.

If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit.

Credit line requested $____________________ (If greater than the minimum listed above.) 

Applicant information (Please print clearly. All information is required to process.) 
Are you a citizen or permanent resident of the United States? 

 Yes  No 

_____________________________________________ 
(as you wish it to appear on the card) 
Name 

____________________ 
Date of Birth 

____________________ 
Social Security # 

____________________ 
Mother’s Maiden Name 

_____________________________________________ 
Street Address 

____________________             ____________________        
How Long at Address  

Home Phone 

____________________ 
UICCU Member Number 

_________________________________________________________________________ 
City 

State 

ZIP 

____________________ 
Cell Phone 

____________________ 
Email Address 

____________________________________________ 
Employer   

____________________ 
Date Employed 

____________________ 
Work Phone 

Do You   Own   Rent 
Payment $___________ 

$___________________ 
Gross Annual Income 

$______________________ 
Other Gross Annual Income (Alimony, child support, or separate maintenance income need not be revealed if you 
do not wish to have it considered as a basis for repaying the obligation). 

Name:___________________________________________City/State:________________________________________Phone Number________________ 

Name:___________________________________________City/State:________________________________________Phone Number________________ 

REQUIRED:  Please list the information of the nearest relatives not living with you. 

Co-applicant information (Please print clearly.) 

_____________________________________________ 
(as you wish it to appear on the card) 
Name 

____________________ 
Date of Birth 

____________________ 
Social Security # 

____________________ 
Mother’s Maiden Name 

_____________________________________________ 
Street Address 

____________________             ____________________        
How Long at Address  

Home Phone 

____________________ 
UICCU Member Number 

_________________________________________________________________________ 
City 

                                                    State 

ZIP 

____________________ 
Cell Phone 

____________________ 
Email Address 

____________________________________________ 
Employer   

____________________ 
Date Employed 

____________________ 
Work Phone 

Do You   Own   Rent 
Payment $___________ 

$___________________ 
Gross Annual Income 

$______________________ 
Other Gross Annual Income (Alimony, child support, or separate maintenance income need not be revealed if you 
do not wish to have it considered as a basis for repaying the obligation). 

 
 
 
 
Interest Rates and Interest Charges 

Introductory Annual 
Percentage Rate (APR) for 
Purchases, Balance Transfers 
and Cash Advances 

A fixed introductory rate of 0% APR shall apply for the first six months.  Thereafter, the APR for all outstanding indebtedness and new balances 
relating to purchase transactions shall be at the rate listed below.

APR for purchases, Balance 
Transfers and Cash Advances 

11.9-12.9%*APR 
Non-Variable Rate 

*Your APR is dependent on your Credit Worthiness

How to Avoid Paying Interest 
on Purchases 

Your due date is at least 25 days after the close of each billing cycle.  We will not charge you any interest on purchases if you pay your entire balance 
by the due date each month.  We will begin charging interest on cash advances and balance transfers on the transaction date. 

Minimum Finance Charge 

None 

For Credit Card Tips from the 
Consumer Financial Protection 
Bureau 
Fees 
Annual Fee 

Transaction Fees 
1.

Internal Balance Transfer 
Fees 
External Balance 
Transfers Fees 
Convenience Check Fees 
Cash Advance Fees 
Foreign Transaction Fees 

2.

3.
4.
5.

Penalty Fees 
•
•
•

Late Payment Fee 
Over-the-Credit Limit Fee 
Returned Check Fee 

To learn more about factors to consider when applying for or using a credit card, visit the website of the Consumer Financial Protection 
Bureau at www.consumerfinance.gov/learnmore. 

None 

1.
2.
3.
4.

5.

•
•
•

None 
None 
None 
Either $5, or 3% of the amount of 
each cash advance, whichever is 
greater 
1% of each foreign transaction in U.S. dollars

Up to $15 
None 
Up to $25 

•
•

•

•

How We Will Calculate Your Interest:  We use a method called “average daily balance (including new purchases).”  See your cardholder agreement for more details. 
Payments:  The minimum monthly payment is 2% of the new balance, or $25.00, whichever is greater.  If the unpaid interest and fees on the account are greater than the 
minimum monthly payment, the minimum monthly payment will become that amount.  Any amount that is past due or prior minimum payments that were not made will also be 
added to the minimum monthly payment amount. 
Loss of Introductory APR: You will lose your Introductory APR if your account becomes delinquent or over the limit. 

This information is accurate as of 01/01/2017. 

PLEDGE OF SHARES.  You grant us a security interest in any of your share accounts with us to secure payment of your Account.  You authorize us to apply any funds in your 

share accounts to the balance owing on your Account if you should default.

SIGNATURE(S) 

1. You promise that everything you have stated in this application is correct to the best of your 
knowledge. If  there are any important changes you will  notify  us in writing immediately.  You 
authorize the UICCU to obtain credit reports in connection with this application for credit and 
for  any  update,  increase,  renewal,  extension  or  collection  of  the  credit  received.  You 
understand that the UICCU will rely on the information in this application and your credit report 
to make its decision. If you request, the UICCU will tell you the name and address of any credit  

bureau from which  it received a credit report on you. It  is  a federal  crime to willfully and 
deliberately  provide  incomplete  or  incorrect  information  on  loan  applications  made  to 
federal credit unions or state chartered credit unions insured by the NCUA.  
2. You understand that the use of your card will constitute acknowledgement of receipt and 
agreement to the terms of the credit card agreement and disclosures. MasterCard may not 
be used for any illegal transactions. 

___________________ 
 Applicant Signature 

 Date 

 ____________________

 Other Applicant Signature 

 Date 

Average Beacon  _________ 

Line-of-Credit amount approved $_____________ 

Is this card replacing an existing UICCU Credit Card? Y/N 

FOR UICCU USE ONLY 

Originated by Employee Number: _____________________

Approved by Employee Number:  _____________________