�CUNA Mutual Group 2016  All Rights Reserved 03111886-AXX00-P-1-090717 (AXX002-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 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 :Youmust complete theApplicant section about yourself andtheOther section about your spouse  if
1. youliveinortheproperty pledged ascollateral islocated inacommunity property state (AK, AZ,CA,ID,LA,NM, NV,TX,WA, WI)
2. yourspouse willusetheaccount, or
3. youarerelying onyour spouse's income asabasis forrepayment. Ifyouarerelying onincome from alimony, child support, orseparate
maintenance, complete theOther section totheextent possible about theperson onwhose payments youarerelying.
Joint Credit :Each Applicant must individually complete appropriate section below. IfCo-Borrower isspouse ofthe Applicant, mark theCo-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
X (Seal)Co-Applicant Date
X (Seal)
 Credit Limit Requested $ If Authorized User, Name:
Guarantor sComplete OTHER section  below.
APPLICANT OTHERCO-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
PROPERTY STATE:COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY
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
BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.NOTICE : ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT
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 03111886-AXX00-P-1-090717 (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
STATE LAW NOTICE (S)
Notice toNebraska Residents :Acredit agreement must beinwriting tobeenforceable under Nebraska law. Toprotect you and usfrom any
misunderstandings ordisappointments, anycontract, promise, undertaking, oroffer toforebear repayment ofmoney ortomake anyother financial
accommodation inconnection with thisloan ofmoney orgrant orextension ofcredit, oranyamendment of,cancellation of,waiver of,orsubstitution for
anyoralloftheterms orprovisions ofanyinstrument ordocument executed inconnection with thisloan ofmoney orgrant orextension ofcredit, must
be in writing to be effective.
Notice toNew York Residents :New York residents may contact theNew York State Department ofFinancial Services toobtain acomparative 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 toOhio Residents :The Ohio laws against discrimination require thatallcreditors make credit equally available toallcreditworthy customers,
andthatcredit reporting agencies maintain separate credit histories oneach individual upon request. The Ohio Civil Rights Commission administers
compliance with this law.
Notice toWisconsin Residents :(1)Noprovision ofanymarital property agreement, unilateral statement under Section 766.59, orcourt decree under
Section 766.70 willadversely affect therights oftheCredit Union unless theCredit Union isfurnished acopy oftheagreement, statement ordecree, or
hasactual knowledge ofitsterms, before thecredit isgranted ortheaccount isopened. (2)Please sign ifyouarenotapplying forthisaccount orloan
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)
CONSENSUAL SECURITY INTEREST
You grant usasecurity interest inallindividual and joint share and/or deposit accounts you have with usnow and inthefuture tosecure
your credit card account. Shares anddeposits inanIRAoranyother account that would lose special taxtreatment under state orfederal law
ifgiven assecurity arenotsubject tothesecurity interest youhave given inyour shares anddeposits. You may withdraw these other shares
unless youareindefault. When youareindefault, youauthorize ustoapply thebalance inthese accounts toanyamounts due. Forexample,
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.
Bysigning orotherwise authenticating below, youareaffirmatively agreeing that youareaware thatgranting asecurity interest isacondition
forthecredit card and you intend togrant asecurity interest .You acknowledge and agree that your pledge does notapply during any
periods when you areacovered borrower under theMilitary Lending Act. Forclarity, you willnotbedeemed acovered borrower, and your
pledge willapply, if:(i)youbecome obligated onacredit transaction orestablish anaccount forcredit when youarenotacovered borrower;
or (ii) you cease to be a covered borrower .
Security Interest Acknowledgement and Agreement Date
X (Seal)Security Interest Acknowledgement and Agreement Date
X (Seal)
SIGNATURES
By signing or otherwise authenticating below:
1. Youpromise thateverything youhave stated inthisapplication iscorrect tothebest ofyour knowledge .Ifthere areanyimportant changes youwill
notify usinwriting immediately. You authorize theCredit Union toobtain credit reports inconnection with thisapplication forcredit andforany
update, increase, renewal,extension,orcollectionofthecreditreceived.YouunderstandthattheCredit Union willrelyontheinformation inthis
application andyour credit report tomake itsdecision. Ifyourequest, theCredit Union willtellyouthename andaddress ofanycredit 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 theuseofyour card willconstitute acknowledgment ofreceipt and agreement totheterms oftheConsumer Credit Card
Agreement and Disclosure.
Applicant�s Signature Date
X (Seal)Other Signature Date
X (Seal)
CREDIT UNION USE ONLY
DATE APPROVED
DECLINEDNUMBER OF CARDS CREDIT LIMIT
$CREDIT CARD NUMBER
Signature s
Date
X (Seal)Date
X (Seal)