APPLICATION AND
                                                 SOLICITATION
                                                  DISCLOSURE
                                                         VISA PLATINUM CREDIT CARD
      Interest Rates and Interest Charges
      Annual Percentage Rate (APR) for Vermont Based Rate
      Purchases
                                 7.25%
                                 This APR will vary with the market based on the Prime Rate.
                                 Standard Rate
                                 11.25%
                                 This APR will vary with the market based on the Prime Rate.
      APR for Balance Transfers  7.25%
                                 This APR will vary with the market based on the Prime Rate.
      APR for Cash Advances      11.25%
                                 This APR will vary with the market based on the Prime Rate.
      Penalty APR and When it Applies None
      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.
      Minimum Interest Charge    None
      For Credit Card Tips from the To learn more about factors to consider when applying for or using a
      Consumer Financial Protection Bureau credit card, visit the website of the Consumer Financial Protection
                                 Bureau at http://www.consumerfinance.gov/learnmore.
      Fees
      Annual Fee
      - Annual Fee               None
      Transaction Fees
      - Balance Transfer Fee     None
      - Cash Advance Fee         None
      - Foreign Transaction Fee  1.00% of each transaction in U.S. dollars
      Penalty Fees
      - Late Payment Fee         Up to $20.00
     How We Will Calculate Your Balance:
     We use a method called "average daily balance (including new purchases)."
     Vermont Based Rate: The Vermont Based APR will apply to purchases identified by the merchant�s processing code.
     This is contingent on how a merchant has set up their processing system and if they use a Vermont state code within their
     address for transactions processed by them.
     Effective Date:
     The information about the costs of the card described in this application is accurate as of: July 3, 2022
     This information may have changed after that date. To find out what may have changed, contact the Credit Union.
                                      SEE NEXT PAGE for more important information about your account.
     � CUNA Mutual Group 2009, 10, 12, 16 All Rights Reserved     04400169-MXC10-C-1-060421 (MXC102-E)
     For California Borrowers, the Vermont Based Rate and Standard Rate 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.
     Other Fees & Disclosures:
     Late Payment Fee:
     Equal to the required minimum payment if you are five or more days late in making a payment. However, the Fee will not
     exceed $20.00.
     Card Replacement Fee:
     $10.00.
     Expedited Card Replacement Fee:
     $40.00.
     Initial Request Stop Payment/Revocation of Authorization Fee:
     $18.00.
     Update to Initial Request Stop Payment/Revocation of Authorization Fee:
     $1.50.
     � CUNA Mutual Group 2009, 10, 12, 16 All Rights Reserved     04400169-MXC10-C-1-060421 (MXC102-E)
                                              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 802/800-371-5162 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-Applicant 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:
     APPLICANT                              OTHER  CO-APPLICANT SPOUSE GUARANTOR OTHER
     NAME (Last - First - Initial)          NAME (Last - First - Initial)
     ACCOUNT NUMBER SOCIAL SECURITY NUMBER/INDIVIDUAL TAX ID NUMBER ACCOUNT NUMBER SOCIAL SECURITY NUMBER/INDIVIDUAL TAX ID 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                 04400169-AXX00-C-1-060721 (AXX002-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
     REFERENCE                              REFERENCE
     NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
     RELATIONSHIP                HOME PHONE RELATIONSHIP               HOME PHONE
     WHAT YOU OWE
                  CREDITOR NAME OTHER THAN THIS CREDIT UNION              OWED BY
     DEBT                                  INTEREST RATE PRESENT BALANCE MONTHLY PAYMENT
                  (Attach additional sheet(s) if necessary)
                                                                        APPLICANT OTHER
        RENT
        FIRST MORTGAGE                          %  $          $
     (Incl. Tax & Ins.)
                                                %  $          $
                                                %  $          $
                                                %  $          $
                                                %  $          $
                                                %  $          $
                                                %  $          $
                                                %  $          $
                                                %  $          $
                                                %  $          $
                                                %  $          $
                                                %  $          $
     LIST ANY NAMES UNDER WHICH YOUR CREDIT REFERENCES        $
     AND CREDIT HISTORY CAN BE CHECKED:    TOTALS  $
     WHAT YOU OWN
                                                         PLEDGED AS COLLATERAL OWNED BY
     ASSET DESCRIPTION LIST LOCATION OF PROPERTY OR FINANCIAL INSTITUTION MARKET VALUE
                                                         FOR ANOTHER LOAN
                                                                     APPLICANT OTHER
                                              $             YES   NO
                                              $             YES   NO
                                              $             YES   NO
                                              $             YES   NO
                                              $             YES   NO
                                              $             YES   NO
                                              $             YES   NO
                               IF YOU ANSWER �YES� (BY CHECKING THE BOX) TO ANY QUESTION OTHER THAN #1,
     OTHER INFORMATION ABOUT YOU EXPLAIN ON AN ATTACHED SHEET        APPLICANT OTHER
        1. ARE YOU A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN?
        2. DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT
          PLAN CONFIRMED UNDER CHAPTER 13, HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS, OR BEEN A PARTY
          IN A LAWSUIT?
        3. IS YOUR INCOME LIKELY TO DECLINE IN THE NEXT TWO YEARS?
        4. ARE YOU A CO-MAKER, CO-SIGNER OR GUARANTOR ON ANY LOAN NOT LISTED ABOVE?
          FOR WHOM (Name of Others Obligated on Loan):
          TO WHOM (Name of Creditor):
                                                                  04400169-AXX00-C-1-060721 (AXX002-E)
     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 the Credit Union 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 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)
     CREDIT CARD 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.
      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, and that the above information is a
        complete listing of what you owe. 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 and for other accounts, products, or services we may offer you or for which you may qualify. 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.
     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)
                                                                  04400169-AXX00-C-1-060721 (AXX002-E)