CREDIT CARD
                                              APPLICATION
       There are costs associated with the use of a credit card. Information about costs, rates and fees may be contained in disclosures provided with this
           application or by calling us toll-free or collect at or writing 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.
      Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if
        1. you live in or the property pledged as collateral is located 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.
      Joint Credit: Each Applicant must individually complete appropriate section below. If Co-Borrower is spouse of the Applicant, mark the Co-Applicant
      box.
      Credit Card Account:  Individual  Joint
      If this is an application for joint credit, Applicant and Co-Applicant each agree and acknowledge the intent to apply for joint credit (sign below):
     Applicant                         Date Co-Applicant                      Date
     X                                 (Seal) X                               (Seal)
        Credit Limit Requested $            If Authorized User, Name:
                                            Guarantors Complete OTHER section below.
     APPLICANT                              OTHER  CO-APPLICANT SPOUSE GUARANTOR OTHER
     NAME (Last - First - Initial)          NAME (Last - First - Initial)
     ACCOUNT NUMBER SOCIAL SECURITY NUMBER  ACCOUNT NUMBER SOCIAL SECURITY NUMBER
     BIRTH DATE     EMAIL ADDRESS           BIRTH DATE    EMAIL ADDRESS
     HOME PHONE   CELL PHONE  BUSINESS PHONE/EXT. HOME PHONE CELL PHONE BUSINESS PHONE/EXT.
     DRIVER�S LICENSE NUMBER/STATE AGES OF DEPENDENTS DRIVER�S LICENSE NUMBER/STATE AGES OF DEPENDENTS
     PRESENT ADDRESS (Street � City � State � Zip) OWN RENT PRESENT ADDRESS (Street � City � State � Zip) OWN RENT
                                LENGTH AT RESIDENCE                   LENGTH AT RESIDENCE
     PREVIOUS ADDRESS (Street � City � State � Zip) OWN RENT PREVIOUS ADDRESS (Street � City � State � Zip) OWN 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
      $           $                 %       $           $                 %
     COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY
     PROPERTY STATE:                        PROPERTY STATE:
       MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed) MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)
     EMPLOYMENT/INCOME   START DATE         EMPLOYMENT/INCOME  START DATE
     EMPLOYMENT STATUS FULL TIME PART TIME  EMPLOYMENT STATUS FULL TIME PART TIME
     NAME AND ADDRESS OF EMPLOYER           NAME AND ADDRESS OF EMPLOYER
     NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT
     BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED. BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.
     EMPLOYMENT INCOME PER OTHER INCOME PER EMPLOYMENT INCOME PER OTHER INCOME PER
      $                  $                  $                  $
     TITLE/GRADE         SOURCE             TITLE/GRADE        SOURCE
     PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN FIVE YEARS PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN FIVE YEARS
     STARTING DATE        ENDING DATE       STARTING DATE       ENDING DATE
      � CUNA Mutual Group 2016 All Rights Reserved                00910226-AXX00-C-1-071117 (AXX001-E)
     MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR? YES  NO MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR? YES NO
     WHERE                     ENDING/SEPARATION DATE WHERE          ENDING/SEPARATION DATE
     CONSENT TO CONTACT
      BY SIGNING BELOW, YOU AUTHORIZE 121 FINANCIAL CREDIT UNION TO DELIVER OR CAUSE TO BE DELIVERED TO YOU AT THE
      TELEPHONE NUMBERS PROVIDED ABOVE, ADVERTISING AND TELEMARKETING CALLS AND TEXT MESSAGE(S) USING AN AUTOMATIC
      TELEPHONE DIALING SYSTEM AND/OR AN ARTIFICIAL OR PRERECORDED VOICE. YOU ARE NOT REQUIRED TO SIGN THIS
      AUTHORIZATION OR ENTER INTO THIS AGREEMENT AS A CONDITION OF PURCHASING ANY PROPERTY, GOODS OR SERVICES. You may
      withdrawal the consent provided herein at any time by providing written notice to us at Attn: Risk Management, PO Box 40769, Jacksonville, Fl 32203,
      by email at ask121@121fcu.org, via phone at 904-723-6300 or by any other reasonable means.
      Applicant�s Signature            Date Other Signature                  Date
     X                                 (Seal) X                              (Seal)
      By executing this application, you agree we and/or our third-party vendors (including debt collectors) may contact you by telephone or text message at
      any telephone number associated with your account, including wireless telephone numbers (i.e. cell phone numbers) which could result in charges to
      you, in order to service your account or collect any amounts owed to us, excluding any contacts for advertising and telemarketing purposes as
      prescribed by law. You further agree methods of contact may include use of pre-recorded or artificial voice messages, and/or use of an automatic dialing
      device. You may withdraw the consent to be contacted on your wireless telephone number(s) at any time by written notice to us at Attn: Risk
      Management, PO Box 40769, Jacksonville, FL 32203, by email to ask121@121fcu.org, via phone at (904) 723-6300 or by any other reasonable means.
      If you have provided a wireless telephone number(s) on or in connection with this application, you represent and agree you are the wireless subscriber
      or customary user with respect to the wireless telephone number(s) provided and have the authority to give this consent. Furthermore, you agree to
      notify us of any change to the wireless telephone number(s) for which you are providing your consent to be contacted. You agree to indemnify us and
      our third-party vendors, and hold us and our third-party vendors, harmless, from and against any and all losses, claims, damages, liabilities, costs of
      expenses (including attorney�s fees) that arise out of your breach of any of the foregoing representations and agreements.
      In order to help mitigate harm to you and your account, we may contact you on any telephone number associated with your account, including a wireless
      telephone number (i.e. cell phone number), to deliver to you any messages related to suspected or actual fraudulent activity on your account, data
      security breaches or identity theft following a data breach, money transfers, or any other exigent messages permitted by applicable law. These contacts
      will not contain any telemarketing, cross-marketing, solicitation, advertising, or debt collection message of any kind. The contacts will be concise and
      limited in frequency as required by law. You will have an opportunity to opt-out of such communications at the time of delivery.
     STATE LAW NOTICE(S)
      Notice to Nebraska Residents: A credit agreement must be in writing to be enforceable under Nebraska law. To protect you and us from any
      misunderstandings or disappointments, any contract, promise, undertaking, or offer to forebear repayment of money or to make any other financial
      accommodation in connection with this loan of money or grant or extension of credit, or any amendment of, cancellation of, waiver of, or substitution for
      any or all of the terms or provisions of any instrument or document executed in connection with this loan of money or grant or extension of credit, must
      be in writing to be effective.
      Notice to New York Residents: New York residents may contact the New York State Department of Financial Services to obtain a comparative listing
      of credit card rates, fees, and grace periods. New York State Department of Financial Services: 1-800-342-3736 or www.dfs.ny.gov.
      Notice to Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers,
      and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers
      compliance with this law.
      Notice to Wisconsin Residents: (1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under
      Section 766.70 will adversely affect the rights of 121 Financial Credit Union unless 121 Financial Credit Union is furnished a copy of the agreement,
      statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying
      for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the
      undersigned.
      Signature for Wisconsin Residents Only Date
      X                                (Seal)
                                                                  00910226-AXX00-C-1-071117 (AXX001-E)
     CONSENSUAL SECURITY INTEREST
      You grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure
      your credit card account. Shares and deposits in an IRA or any other account that would lose special tax treatment under state or federal law
      if given as security are not subject to the security interest you have given in your shares and deposits. You may withdraw these other shares
      unless you are in default. When you are in default, you authorize us to apply the balance in these accounts to any amounts due. For example,
      if you have an unpaid credit card balance, you agree we may use funds in your account(s) to pay any or all of the unpaid balance.
      By signing or otherwise authenticating below, you are affirmatively agreeing that you are aware that granting a security interest is a condition
      for the credit card and you intend to grant a security interest. You acknowledge and agree that your pledge does not apply during any
      periods when you are a covered borrower under the Military Lending Act. For clarity, you will not be deemed a covered borrower, and your
      pledge will apply, if: (i) you become obligated on a credit transaction or establish an account for credit when you are not a covered borrower;
      or (ii) you cease to be a covered borrower.
      Security Interest Acknowledgement and Agreement Date Security Interest Acknowledgement and Agreement Date
     X                                 (Seal) X                              (Seal)
     SIGNATURES
      By signing or otherwise authenticating below:
      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 121 Financial Credit Union 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 also authorize 121 Financial Credit Union to investigate and
        verify any information provided in connection with this application including current and previous employment. You understand that 121 Financial
        Credit Union will rely on the information in this application and your credit report to make its decision. If you request, 121 Financial Credit Union will
        tell you the name and address of any credit bureau from which it received a credit report on you. It is a crime to willfully and deliberately provide
        incomplete or incorrect information in this application.
      2. You understand that the use of your card will constitute acknowledgment of receipt and agreement to the terms of the Consumer Credit Card
        Agreement and Disclosure.
      Applicant�s Signature            Date Other Signature                  Date
     X                                 (Seal) X                              (Seal)
      CREDIT UNION USE ONLY
     DATE    APPROVED NUMBER OF CARDS CREDIT LIMIT CREDIT CARD NUMBER
             DECLINED         $
      Signatures
                                    Date                                  Date
     X                              (Seal)  X                             (Seal)
                                                                  00910226-AXX00-C-1-071117 (AXX001-E)
                                APPLICATION AND  
                                                 SOLICITATION      
                                DISCLOSURE  
                                             VISA PLATINUM/VISA PLATINUM REWARDS/VISA   
                                                                        SIGNATURE  
      Interest Rates and Interest Charges    
      Annual Percentage Rate (APR) for  Visa Platinum  
      Purchases  
                                 9.74% , 11.99%, 14.40%, 14.49% or 14.89%    ,   
                                 based on your creditworthiness.  
                                 Visa Platinum Rewards  
                                 10.74%, 11.74%, 12.74%, 15.74% or 17.74%     ,   
                                 when you open your account, based on your creditworthiness. This APR will 
                                 vary with the market based on the Prime Rate.  
                                 Visa Signature  
                                 11.74%, 12.74%, 15.74%, 16.74% or 17.74%     ,   
                                 when you open your account, based on your creditworthiness. This APR will 
                                 vary with the market based on the Prime Rate.  
      APR for Balance Transfers   Visa Platinum  
                                 9.74% , 11.99%, 14.40%, 14.49% or 14.89%, based on your 
                                 creditworthiness.  
                                 Visa Platinum Rewards  
                                 10.74%, 11.74%, 12.74%, 15.74% or 17.74%, when you open your account, 
                                 based on your creditworthiness. This APR will vary with the market based on 
                                 the Prime Rate.  
                                 Visa Signature  
                                 11.74%, 12.74%, 15.74%, 16.74% or 17.74%, when you open your account, 
                                 based on your creditworthiness. This APR will vary with the market based on 
                                 the Prime Rate.  
      APR for Cash Advances      Visa Platinum  
                                 9.74% , 11.99%, 14.40%, 14.49% or 14.89%, based on your 
                                 creditworthiness.  
                                 Visa Platinum Rewards  
                                 10.74%, 11.74%, 12.74%, 15.74% or 17.74%, when you open your account, 
                                 based on your creditworthiness. This APR will vary with the market based on 
                                 the Prime Rate.  
                                 Visa Signature  
                                 11.74%, 12.74%, 15.74%, 16.74% or 17.74%, when you open your account, 
                                 based on your creditworthiness. This APR will vary with the market based on 
                                 the Prime Rate.  
                                      SEE NEXT PAGE for more important information about your account.  
     � CUNA Mutual Group 2009, 10, 12, 16 All Rights Reserved   00910226-MXC10-P-1-071117 (MXC101-E)  
      Penalty APR and When it Applies   Visa Platinum  
                                 17.90%  
                                 Visa Platinum Rewards  
                                 17.90%  
                                 Visa Signature  
                                 17.90%  
                                 This APR may be applied to 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 six consecutive minimum 
                                 payments when due.  
      How to Avoid Paying Interest on  Your due date is at least 25 days after the close of each billing cycle. We will 
      Purchases                  not charge you any interest on purchases if you pay your entire balance by 
                                 the due date each month.  
      For Credit Card Tips from the   To learn more about factors to consider when applying for or using a credit 
      Consumer Financial Protection Bureau   card, visit the website of the Consumer Financial Protection Bureau at 
                                 http://www.consumerfinance.gov/learnmore.  
      Fees    
      Annual Fee  
      - Annual Fee - Visa Platinum, Visa  
                                 None  
      Platinum Rewards  
      - Annual Fee - Visa Signature  
                                 $75.00  
      Transaction Fees  
      - Balance Transfer Fee  
                                 None  
      - Cash Advance Fee - Visa Platinum, Visa  
                                 $5.00 or 2.00% of the amount of each cash advance, whichever is greater 
      Platinum Rewards           (Maximum Fee: $500.00)  
      - Cash Advance Fee - Visa Signature   $10.00 or 3.00% of the amount of each cash advance, whichever is greater  
                                 (Maximum Fee: $500.00)  
      - Foreign Transaction Fee  
                                 1.00% of each transaction in U.S. dollars  
      Penalty Fees  
      - Late Payment Fee  
                                 Up to $25.00  
      - Over-the-Credit Limit Fee  
                                 None  
      - Returned Payment Fee  
                                 Up to $25.00  
     How We Will Calculate Your Balance:  
     We use a method called "average daily balance (including new purchases)."  
     Application of Penalty APR:  
     Your APR may be increased to the disclosed Penalty APR if you are 60 days late in making a payment.  
     Effective Date:  
     The information about the costs of the card described in this application is accurate as of: July 1, 2017  
     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 Signature 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 
     � CUNA Mutual Group 2009, 10, 12, 16 All Rights Reserved   00910226-MXC10-P-1-071117 (MXC101-E)  
     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  
                                      SEE NEXT PAGE for more important information about your 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 Fees & Disclosures:  
     Late Payment Fee:  
     $25.00 or the amount of the required minimum payment, whichever is less, if you are five or more days late in making a 
     payment.  
     Annual Fee - Visa Signature: 
     $75.00.  
     Cash Advance Fee (Finance Charge) - Visa Platinum, Visa Platinum Rewards:  
     $5.00 or 2.00% of the amount of each cash advance, whichever is greater, however, the fee will never exceed $500.00.  
     Cash Advance Fee (Finance Charge) - Visa Signature:  
     $10.00 or 3.00% of the amount of each cash advance, whichever is greater, however, the fee will never exceed $500.00.  
     Returned Payment Fee:  
     $25.00 or the amount of the required minimum payment, whichever is less.  
     Returned Convenience Check Fee:  
     $27.00 or the amount of the returned convenience check, whichever is less.  
     Card Replacement Fee: $10.00.  
     Document   Copy   Fee:  
     $2.00 per document.  
     Pay-by-Phone Fee: $5.00.  
     Rush Fee:  
     $50.00 second day.  
     Statement Copy Fee: $5.00 
     per page.  
       
       
       
       
       
       
       
       
       
       
     � CUNA Mutual Group 2009, 10, 12, 16 All Rights Reserved   00910226-MXC10-P-1-071117 (MXC101-E)