CREDIT CARD ACCOUNT OPENING DISCLOSURE

F1  

This Addendum is incorporated into and becomes part of your LOANLINER® Consumer Credit Card Agreement. 
Please keep this attached to your LOANLINER® Consumer Credit Card Agreement. 

Interest Rates and Interest Charges 
Annual Percentage Rate (APR) for 
Purchases 
APR for Balance Transfers 
APR for Cash Advances 
Paying Interest 

For Credit Card Tips from the Consumer 
Financial Protection Bureau 

F2             
F3             
F4             
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.  
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 http://www.consumerfinance.gov/learnmore. 

Fees 
Transaction Fees 
-  Foreign Transaction Fee 
Penalty Fees 
-  Late Payment Fee 
-  Over-the-Credit Limit Fee 
-  Returned Payment Fee 

F5             of each transaction in U.S. dollars 

Up to F6              
Up to F7             
Up to F8             

How We Will Calculate Your Balance. We use a method called “average daily balance (excluding new purchases).” See 
your account Agreement for more details. 

Billing  Rights.  Information  on  your  rights  to  dispute  transactions  and  how  to  exercise  those  rights  is  provided  in  your 
account Agreement.  

OTHER DISCLOSURES 

Late Payment Fee 

Over-the-Credit Limit Fee 

Returned Payment Fee 

Statement Copy Fee 
Rush Fee 
PIN Replacement Fee 
Card Replacement Fee 

Periodic Rates. 

F9             or the amount of the required minimum payment, whichever 
is less, if you are five (5) or more days late in making a payment. 
F10           or the amount of the transaction exceeding your credit limit, 
whichever is less. 
F11           or the amount of the required minimum payment, whichever 
is less. 
F12           
F13           
F14           
F15           

The Purchase APR is F16           which is a monthly periodic rate of F17           
The Balance Transfer APR is F18           which is a monthly periodic rate of F19           
The Cash Advance APR is F20           which is a monthly periodic rate of F21           

©CUNA Mutual Group 2009, 10, 12 All Rights Reserved 

DWIJE3 (MXC452 CCM002)-e 

  
 
 
 
 
 
Credit Card Application
A table that includes required credit card disclosures is on a separate
document provided with this Application. To obtain any change in the
required information since it was printed, call us toll
free at
________________.

A table that includes required credit card disclosures is on a separate

document provided with this Application. To obtain any change in the

required information since it was printed, call us toll

free at

_________________________ or write 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.

Guarantor: Complete the Other section if you are a guarantor on an account/loan.

Credit Limit Requested $

APPLICANT

NAME (Last - First - Initial)

OTHER

NAME (Last - First - Initial)

CO-APPLICANT

SPOUSE

GUARANTOR

ACCOUNT NUMBER

SOCIAL SECURITY NUMBER

ACCOUNT NUMBER

SOCIAL SECURITY NUMBER

DRIVER'S LICENSE NUMBER/STATE

EMAIL ADDRESS

DRIVER'S LICENSE NUMBER/STATE

EMAIL ADDRESS

BIRTH DATE

HOME PHONE

BUSINESS PHONE/EXT.

BIRTH DATE

HOME PHONE

BUSINESS PHONE/EXT.

PRESENT ADDRESS (Street - City - State - Zip)

OWN

RENT

LENGTH AT RESIDENCE

PRESENT ADDRESS (Street - City - State - Zip)

OWN

RENT

LENGTH AT RESIDENCE

MORTGAGE/RENT OWED TO:

MORTGAGE/RENT OWED TO:

MORTGAGE BALANCE
$
COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY
STATE:

MONTHLY PAYMENT
$

INTEREST RATE
%

UNMARRIED (Single - Divorced - Widowed)

SEPARATED

MARRIED

MORTGAGE BALANCE
$
COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY
STATE:

MONTHLY PAYMENT
$

INTEREST RATE
%

UNMARRIED (Single - Divorced - Widowed)

SEPARATED

MARRIED

EMPLOYMENT/INCOME

START DATE

EMPLOYMENT/INCOME

START DATE

NAME AND 
ADDRESS OF 
EMPLOYER

NAME AND
ADDRESS OF 
EMPLOYER

NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE

NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE

REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.

REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.

EMPLOYMENT INCOME

$_____________ Per ______________

OTHER INCOME
$_____________ Per ______________

EMPLOYMENT INCOME
$_____________ Per _____________

OTHER INCOME
$_____________ Per _______________

NET

GROSS

SOURCE

NET

GROSS

SOURCE

STATE LAW NOTICES

OHIO RESIDENTS ONLY: 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.

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.

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 Union

X

SIGNATURE FOR WISCONSIN RESIDENTS ONLY

DATE

SIGNATURES

increase,

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
renewal, extension, or collection of the credit
any update,
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 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 NCUA.

of your

the use

card will

understand that

2. You
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.

X

APPLICANT'S SIGNATURE

(SEAL)

X

DATE

OTHER SIGNATURE

CREDIT UNION USE ONLY

APPROVED

NO. OF CARDS

CREDIT LIMIT $

CREDIT CARD NUMBER

DECLINED

CREDIT COMMITTEE OR LOAN OFFICER SIGNATURE

CUNA MUTUAL GROUP, 2009 ALL RIGHTS RESERVED

(SEAL)

DATE

AXC001-e