Merced School Employees Federal Credit Union 1021 Olivewood Drive * PO Box 1349 Merced. CA 95348 209-383-5550 »* 800-542-2345 Fax: 209-383-0390 MSEFCU www.mercedschoolcu.org LQUSNLINER. VISA 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 _800-542-2345 :   Check below to indicate the type of credit for which you are applying. Married Applicants may apply for a separate account.   2. your spouse will use the account, or box. Guarantor: Complete the Other section if you are a guarantor on an account/loan. Oilndividual 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); 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 LC Credit Limit Requested $   APPLICANT OTHER | C1 co-appiicant (] spouse L] oTHER   NAME (Last - First - Initial)   NAME (Last - First - Initial)   ACCOUNT NUMBER SOCIAL SECURITY NUMBER         ACCOUNT NUMBER SOCIAL SECURITY NUMBER                         COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE: ["] MARRIED [_]SEPARATED [_] UNMARRIED (Single - Divorced - Widowed) DRIVER'S LICENSE NUMBER/STATE EMAIL ADDRESS DRIVER'S LICENSE NUMBER/STATE EMAIL ADDRESS BIRTH DATE HOME PHONE CELL PHONE BUSINESS PHONE/EXT. BIRTH DATE HOME PHONE CELL PHONE BUSINESS PHONE/EXT. PRESENT ADDRESS (Street - City - State - Zip) [Lown [J rent PRESENT ADDRESS (Street - City - State - Zip) Clown [J 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: []marRIED [_]SEPARATED [_] UNMARRIED (Single - Divorced - Widowed)   EMPLOYMENT/INCOME START DATE NAME AND ADDRESS OF EMPLOYER     EMPLOYMENT/INCOME START DATE 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 OTHER INCOME $ Per $ OO ner 0 cross SOURCE Per       EMPLOYMENT INCOME OTHER INCOME $ Per $ OO ner OO cross SOURCE Per         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. WISCONSIN RESIDENTS ONLY: (1) No agreement, unilateral statement under   rovision of any marital property ection 766.59, or court decree 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. [x         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. under Section 766.70 will adversely affect the rights of the Credit Union SIGNATURE FOR WISCONSIN RESIDENTS ONLY DATE SIGNATURES 1. You promise that everything you have stated in this application is 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.   (SEAL)   [Xx | xX (SEAL) l                 APPLICANT'S SIGNATURE DATE OTHER SIGNATURE DATE CREDIT UNION USE ONLY (J APPROVED NO. OF CARDS___ CREDIT LIMIT $ CREDIT CARD NUMBER LIDECLINED CREDIT COMMITTEE OR LOAN OFFICER SIGNATURE © CUNA Mutual Group 2009 All Rights Reserved AXCO002-e