AXC002-e CUNA Mutual Group 2009 All Rights ReservedDRIVER'S LICENSE NUMBER/STATEACCOUNT NUMBER
OHIO RESIDENTS ONLY: The Ohio laws
against discrimination require that all creditorsSOCIAL SECURITY NUMBER
NAME AND
ADDRESS OF 
EMPLOYERLENGTH AT RESIDENCENAME (Last - First - Initial)
DRIVER'S LICENSE NUMBER/STATEACCOUNT NUMBER SOCIAL SECURITY NUMBER
NAME AND 
ADDRESS OF 
EMPLOYERINTEREST RATE
NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE
REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.LENGTH AT RESIDENCE
%
NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE
REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.EMPLOYMENT/INCOMENAME (Last - First - Initial)Check below to indicate the type of credit for which you are applying.  Married Applicants may apply for a separate account.
OWN RENTAPPLICANT
EMPLOYMENT/INCOME
unless the 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 notapplying
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 DATESTATE LAW NOTICES
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.
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 affect the rights of the Credit UnionPRESENT ADDRESS (Street - City - State - Zip)
MORTGAGE/RENT OWED TO:
MORTGAGE BALANCE MONTHLY PAYMENT
$ $INTEREST RATE
%MORTGAGE/RENT OWED TO:
MORTGAGE BALANCE MONTHLY PAYMENT
$ $
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:
START DATE START DATE
XEMAIL ADDRESS EMAIL ADDRESS
OTHER SIGNATURE APPLICANT'S SIGNATURE DATE DATE(SEAL) (SEAL)SIGNATURES
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 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 understand that the Credit Union will rely on the information
in this application and your credit report to make its decision. If you
request, the 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.
X XCredit Limit Requested $
OWN RENT
MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)
$_____________ Per ______________ $_____________ Per ______________EMPLOYMENT INCOME OTHER INCOME
GROSS NET SOURCECO-APPLICANT SPOUSE OTHER
$_____________ Per _______________EMPLOYMENT INCOME OTHER INCOME
GROSS$_____________ Per _____________
SOURCE NETMARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)PRESENT ADDRESS (Street - City - State - Zip)OTHER
2. You understand that the use of your card will constitute
acknowledgment of receipt and agreement to the terms of the credit card
agreement and disclosures. 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. When you are in
default, you authorize us to apply the balance in these accounts to any
amounts due. Shares and deposits in an Individual Retirement Account,
and 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.Joint Credit: Each Applicant must individually complete appropriate section below. If Co-Borrower is spouse of the applicant, mark the Co-Applicant
box.Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:
Guarantor: Complete the Other section if you are a guarantor on an account/loan.Credit Card Application
APPROVED
DECLINEDNO. OF CARDS CREDIT LIMIT $
CREDIT COMMITTEE OR LOAN OFFICER SIGNATURECREDIT CARD NUMBERCREDIT UNION USE ONLY1. 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.
BUSINESS PHONE/EXT. CELL PHONE HOME PHONE BIRTH DATE BUSINESS PHONE/EXT. CELL PHONE HOME PHONE BIRTH DATE  A table that includes required credit card disclosures is on a separate document provided with this Applicat ion. To obtain any change in the required information since it was printed, write to us at the address stated on this Application.    
 �CUNA Mutual Group 2009,  10, 12 All Rights Reserved D42NW1 (MXC402 CCM002)   
 
 
 
 
F1             
APPLICATION AND SOLI CITATION DISCLOSURE   
Interest Rates and Interest Charges  
Annual Percentage Rate (APR) for 
Purchases  Standard MasterCard  
F2          to F3          when you open your account , based 
on your creditworthiness.  
 
Gold  MasterCard  
F4          to F5          when you open your account , based 
on your creditworthiness.  
APR for Cash Advances  Standard MasterCard  
F6          to F7          when you open your account , based on your 
creditworthiness.  
 
Gold MasterCard  
F8          to F9          when you open your account , based on your 
creditworthiness.  
Paying Interest  We will begin charging interest on purchases on the transaction date.  
For Credit Card Tips from the Consumer 
Financial Protection Bureau  To learn more about fac tors to consider when applying for or 
using a credit card, visit the web site of the Consumer Financial 
Protection Bureau  at http://www. consumerfinance.gov/learnmore . 
Fees 
Transaction  Fees   
- Foreign Transaction Fee  F10        of each transaction in U.S . dollars  
Penalty  Fees   
- Late Payment Fee  Up to F11            
- Returned Payment Fee  Up to F12           
- Returned ACH Payment Fee  Up to F13           
 
How We Will Calculate Your Balance.  We use a method called � average daily balance (including new purchases).�  
Effective Date.  
The information about the costs of the card described in this application is accurate as of F14            
This information may have changed after that date. To find out what may have changed, contact the Credit Union. 
OTHER DISCLOSURES 
Late Payment Fee F15        or the amount of the required minimum payment, whichever is 
less, if you are ten (10) or more days late in making a payment. 
Returned Payment Fee F16        or the amount of the required minimum payment, whichever i s 
less. 
Returned ACH Payment Fee F17        or the amount of the required minimum payment, whichever is 
less. 
Card Replacement Fee F18           
Rush Fee F19        2 days $55 Overnight 
Stop Payment Fee F20           
 
STANDARD MASTERCARD/GOLD MASTERCARD
5.90%
18.00%
5.90%
18.00%
5.90%
18.00%
5.90%
18.00%
1.00%
$25.00
$25.00
$25.00
February 1, 2014.
$25.00
$25.00
$25.00
$5.00
$27.50
$12.00