18540 Northwest Freeway  
Houston, TX 77065  
Phone:  832-604-4848 � 866-614-9298  
www.eccu.net  CREDIT CARD  APPLICATION  
 Date  Account Number  
APPLICANT INFORMATION. Married Applicants may apply for an individual loan /separate account.   
Type of Credit.  Check the type of credit for which you wish to apply.  
   Individual credit  -- If you are applying for individual credit, complete the Applicant section.   
   Joint credit  � If you are ap plying for joint credit with your spouse or another person, complete the Applicant section and the Spouse/Co -Applicant section.  
 
You must initial here if you intend to apply for Joint Credit:  X                             X                         _ 
Spous e Information.  You must also complete the Spouse section if any of the following apply:  (1) your spouse will use your account; (2) you are relying on your spouse�s income as a source 
of repayment; (3) you live in a community property state (AZ, CA, ID, LA , NM, NV, TX, WA, WI or Puerto Rico); or (4) you are an Alaska resident and are currently subject to a community 
property agreement or community property trust.  
 
Credit Limit Requested:   $______________ ___          No. of Cards: _______  Authorized User Na me: __________________________ ________________ _____________  
You understand that by using the credit card (�card�), or allowing another to use the card; you agree that such use constitute s your acknowledgment, receipt and agreement to the terms and 
conditi ons of the credit card agreement provided to you in connection  with the card or credit line. Refer to the  separate table that includes req uired credit card disclosures  being furnished with 
this Application . To obtain any change in the required information since it was printed, please call us at 832-604-4848  or write  to us at the addr ess stated on this Application.  
Optional Payment Protection  � If you answer �yes� t he Credit Union will disclose the cost of optional payment protection  to you. A separate elec tion that discloses the terms and condit ions 
must be signed for protection  to become effective.   Are you interested in  having this loan protected?     Yes    No 
APPLICANT       SPOUSE     CO-APPLICANT    GUARANTOR  
Complete only if: (a) credit will be secured by collateral; or (b) you live in a community property 
state; or (c) you are an Alaska resident subject to a community property agreement or community 
property trust:  
 MARRIED     SEPARATED      UNMARRIED (Single, Divorced, Widowed)   Complete only if: (a) credit will be secured by collateral; or (b) you live in a community property 
state; or (c) you are an Alaska reside nt subject to a community property agreement or 
community property trust:  
 MARRIED     SEPARATED      UNMARRIED (Single, Divorced, Widowed)  
APPLICANT NAME   SPOUSE/CO -APPLICANT NAME  
SOCIAL SECURITY NO.  DRIVER�S LICENSE NO. & STATE  BIRTH DATE   SOCIAL SECURITY NO.  DRIVER�S LICENSE NO. & STATE  BIRTH DATE  
HOME PHONE NO.  CELL PHONE  MOTHER�S MAIDEN NAME   HOME PHONE NO.  CELL PHONE  MOTHER�S MAIDEN NAME  
E-MAIL ADDRESS   E-MAIL ADDRESS  
CURRENT STREET ADDRESS  (Stre et/City/State/Zip)  SINCE   CURRENT STREET ADDRESS  (Street/City/State/Zip)  SINCE  
 DO YOU:  
 OWN     RENT    DO YOU:  
 OWN     RENT  
PERSONAL REFERENCE (Name and Address)  RELATIONSHIP   PERSONAL  REFERENCE (Name and Address)  RELATIONSHIP  
PHONE NO.  PHONE NO.  
 
EMPLOYMENT & INCOME  You need not list income from alimony, child support or separate maintenance unless you wish it considered for purposes of gr anting this credit.  
EMPLOYER  (Name and Ad dress)  HIRE DATE   EMPLOYER  (Name and Address)  HIRE DATE  
 WORK PHONE NO.  
   WORK PHONE NO.  
MONTHLY GROSS INCOME  
 
$ OTHER  MONTHLY INCOME  
 
$ SOURCE   MONTHLY GROSS INCOME  
 
$ OTHER  MONTHLY INCOME  
 
$ SOURCE  
SIGNATURES � Are you currently on active military du ty?  Yes   No 
You promise that the information stated in this  Credit Card Application is true and correct to the best of your knowledge. You authorize the Credit Union to obtain credit reports when u pdating its records in  connection with any 
review, increase, extension or renewal of credit, and in connection with any collection activities involving credit extended to you.  The Credit Union may also obtain credit reports to update, increase, extend, renew or collection of 
the credit received by you. False or misleading statements in your application may cause any loan to be in default. You agree t hat this application shall be the Credit Union�s property whether or not this application is approved. 
You will notify the Credit U nion in writing immediately of any changes in your name, address or employment. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information to 
obtain credit. If you request, you will be provided the n ame and address of any credit bureau from which we received a credit report. You understand and agree that if your application is approved, that any collateral described in 
any security agreement, pledge, advance disbursement voucher or similar document th at may be executed, now or in the future, in connection with such credit will secure the Credit Union for repayment of funds advanced to you, 
subject to the terms and conditions of such security agreement, pledge, advance disbursement voucher or similar do cument.  CONSENSUAL SECURITY INTEREST. You further acknowledge and agree that you give the 
Credit Union a consensual security interest in the shares you have in all individual and joint accounts you have with the Cre dit Union, now and in the future (other t han those accounts that would have an 
adverse tax consequence if pledged as collateral), to secure repayment of amounts you owe to the extent of any unpaid balance  on your Account.  
 
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial 
institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you ope n an account, we will ask for your name, address, date of birth, and other 
information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.  
OHIO RESIDENTS:  The Ohio laws against discrimination req uires that all creditors make credit equally available to all credit worthy customers and that credit reporting agencies main tain separate credit histories on 
each individual upon request. The Ohio civil rights commission administers compliance with this l aw. 
WISCONSIN RESIDENTS:  For any provision of any marital property agreement, court decree under WI ST � 766.70, or statement under WI ST � 766.59 to adversely affect the rights of the Credit Union, the Credit Union 
must be provided with a copy of the Agre ement, decree or statement or have actual knowledge of its terms before any credit is approved or account opened. Sign if you  are NOT applying for this loan account with your 
spouse. This credit request, if approved, will be incurred in the interest of the  marriage or family of the undersigned.  
 
Wisconsin Resident Signature _________________________________________________ Date __________________  
 
X  X 
Applicant  Date   Spouse/Co -Applicant /Guarantor  Date  
Credit Union Use Only  
Approved  Yes    No, Reason _________________________________________________      No. of Cards: ______  Credit Limit: ___________________    
 
 ECOA Notice and reason for Rejection sent or delivered on _________________      Loan Officer  Signature __________________________________________________________Date _______________________  
Copyright 2011 ConmarSystems, Peachtree City, GA  30269 � EFORM 19016 -1 Rev. 7/15  Page 1 of 2  
    CREDIT CARD SOLICITATION DISCLOSURE  
 
IF YOU ARE APPLYI NG FOR A CREDIT CARD, THE FOLLOWING IS YOUR REQUIRED DISCLOSURE INFORMATION  - The information provided in this 
disclosure is accurate as of _______________________ . The information may have changed after that date. To find out what may have changed call us  at 
832-604-4848  or write us at 18540 Northwest Freeway, Houston, TX 77065 . Before we approve you for a credit card, we will review your credit report, and the 
information you provide with your application to confirm that you meet the criteria for this off er. The full terms and conditions will be outlined in the Credit Card 
Agreement and Disclosure which will be sent to you with the new card(s).  
Interest Rates and Interest Charges  
ANNUAL PERCENTAGE RATE  
for Purchases  11.40 % - 18.00%  
When you open your acc ount based on your creditworthiness.  
Your APR will vary with the market based on the Prime Rate.  
ANNUAL PERCENTAGE RATE  
for Balance Transfers  11.40 % - 18.00%  
When you open your account based on your creditworthiness.  
Your APR will vary with the market bas ed on the Prime Rate.  
ANNUAL PERCENTAGE RATE  
for Cash Advances  11.40 % - 18.00%  
When you open your account based on your creditworthiness.  
Your APR will vary with the market based on the Prime Rate.  
How to Avoid Paying Interest  Your due date is at least 2 5 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.  
Minimum Interest Charge  None  
For Credit Card Tips f rom 
the Consumer Financial Protection Bureau  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  
Set-up and Maintenance Fees   None  
Transaction Fees  
 Cash Adva nce  
 Foreign Transactions   
3% of the advance, $35 maximum   
1% of each transaction in U.S. dollars  
Penalty Fees  
 Late Payment  
Return ed Payment   
Up to $25.00  
Up to $25.00  
How We Will Calculate Your Balance: We use a method called �Average Daily Balance ( including new purchases)�.  
Other Fees:  
Late Payment:  
Pay By Phone Fee:            
Card Replacement Fee:     
Rush  Fee: 
Document Copy Fee:  If your payment is 10 or more days late you will be charged up to $25.00 . 
$ 4.00  
$ 5.00  
Varies  
$ 5.00  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Copyright 2011 ConmarSystems, Peachtree City, GA  30269 �   EFORM 19016 -1 Rev. 7/15   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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