STUDENT MASTERCARD APPLICATION 
 Visit uiccu.org for a complete list of card benefits. 

With a credit line of just $500, our Student MasterCard allows you to build  
credit without building a pile of debt. 

APPLICANT INFORMATION (Please print clearly.  All information is required.) 

Are you a citizen or permanent resident of the United States? 

 Yes 

  No 

_____________________________________________ 
(as you wish it to appear on the card) 
Name 

____________________ 
Date of Birth 

____________________ 
Social Security # 

____________________ 
Mother’s Maiden Name 

_____________________________________________      ____________________ 
Street Address 

Phone Number 

____________________ 
Email Address 

____________________ 
UICCU Member Number 

_____________________________________________   ____________________________________________ 
City, State   

Name of college or university at which you are enrolled   

Zip 

_____________________________________________ 
Employer  

____________________ 
How Long at Employer 

$__________ 
_____________ 
Hourly Wage           Hours per Week 

Name:____________________________Address:_____________________________________________Telephone Number___________________________________ 

REQUIRED:  Please list the information of the nearest relative not living with you. 

Name:____________________________Address:_____________________________________________Telephone Number___________________________________ 

REQUIRED:  Please list the information of a second relative not living with you. 

OTHER APPLICANT INFORMATION (if applicable) 

_____________________________________________ 
Name 

(no plastic will be issued unless requested) 

____________________ 
Date of Birth 

____________________ 
Social Security # 

____________________ 
Mother’s Maiden Name 

_____________________________________________      ____________________  
Street Address 

How Long at Address 

  ____________________        ____________________ 
Home Phone 

Email Address 

____________________________________________________________________ 
City 

State 

ZIP 

____________________ 
Cell Phone 

Do You   Own   Rent  
Payment $___________ 

_____________________________________________      ____________________ 
Employer  

How Long at Employer 

____________________ 
Work Phone 

$___________________ 
Gross Annual Income 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Interest Rate and Interest Charges 

Introductory Annual Percentage 
Rate (APR) for Purchases, 
Balance Transfers and Cash 
Advances 

APR for purchases, Balance 
Transfers and Cash Advances 

A fixed Introductory rate of 0%-11.9%* shall apply for the first six months.  Thereafter, the APR for all outstanding 
indebtedness and new balances relating to purchas e transactions shall be at the rate listed below.
11.9 – 18.9%* 

* Your APR is dependent on your Credit Worthiness

Non- Variable Rate 

How to Avoid Paying Interest 
on Purchases 

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. 

Minimum Finance Charge 

None 

For Credit Card Tips from 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 www.consumerfinance.gov/learnmore. 

Annual Fee 

None 

Transaction Fees 
1.

Internal Balance Transfer Fees

2. External Balance Transfer Fees

3. Convenience Check Fees 
4. Cash Advance Fees 
5. Foreign Transaction Fees 

1. None 
2. None 
3. None 
4. Either $5, or 3% of the amount of each
cash advance, whichever is greater 
5. 1% of each foreign transaction in U.S. 

dollars

Other Fees & Charges 

Card Replacement Fee (for any reason): $10.00 

Penalty Fees 

1.

2.

3.

Late Payment Fee 

Over-the-Credit Limit Fee 

Returned Check Fee 

1.

2.

3.

Up to $15 

None 

Up to $25 

•

•

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How We Will Calculate Your Interest:  We use a method called “average daily balance (including new purchases).”  See your cardholder agreement for more details. 
Payments:  The minimum monthly payment is 2% of the new balance, or $25.00, whichever is greater.  If the unpaid interest and fees on the account are greater than the 
minimum monthly payment, the minimum monthly payment will become that amount.  Any amount that is past due or prior minimum payments that were not made will also be 
added to the minimum monthly payment amount. 
Loss of Introductory APR: You will lose your Introductory APR if your account becomes delinquent or over the limit. 
This information is accurate as of 12/01/2015. 

PLEDGE OF SHARES.  You grant us a security interest in any of your share accounts with us to secure payment of your Account.  You authorize us to apply any funds in your 

share accounts to the balance owing on your Account if you should default.

SIGNATURE(S) 

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  UICCU  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  UICCU  will  rely  on  the 
information  in  this  application  and  your  credit  report  to  make  its  decision.  If  you 
request, the UICCU 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 the NCUA.  
2. You pledge as security all share and dividends and, if any, all deposits and interest
in  all  joint  and  individual  accounts  you  have  with  us  now  and  in  the  future.    Your 
pledged shares may be withdrawn by you unless you are in default.  The credit  

union  may  have  what  is  known  as  a  statutory  lien  on  all  individual  and  joint 
accounts that you have with us.  A statutory lien means we have the right under 
federal law and many state laws to claim an interest in your accounts.  We can 
enforce  a  statutory  lien  against  your  shares  and  dividends,  and  if  any,  interest 
and deposits, in all individual and joint accounts you have with us to satisfy any 
outstanding financial obligation that is due and payable to us.  We may exercise 
our right to enforce this lien without further notice to you, to the extent permitted 
by law.  The statutory lien will allow us to apply the funds in your account(s) to 
what you owe when you are in default.  The statutory lien does not apply to any 
Individual Retirement Account or any other account that would lose special tax 
treatment under state or federal law if given as security. 
3.You understand that the use of your card will constitute acknowledgement of
receipt and agreement to the terms of the credit card agreement and disclosures. 
MasterCard may not be used for any illegal transactions. 

___________________ 
     Applicant Signature
Date    
FOR UICCU USE ONLY Approval Checklist 

___________________ 
Date 

          Other Applicant Signature

The member is currently enrolled at a 2 or 4 year college or university(vocational or technical schools do not qualify) 
2 references above and all information is complete 
Member has a checking account with the UICCU 
 One of the following is complete if Student only on application (please indicate which item) 

The member has no credit score  or  

The member credit score exceeds 640 

 Member has one of the following if Student and a co-applicant are on application (please indicate which item) 

      Co-Applicant credit score exceeds 640  or  

 Properly approved exception to score requirement obtained and noted in SAIL 

 Member has employment income and  D/I Ratio is <45% not including housing expenses or student loans (either as income or obligations) 

     or  Co-applicant present  and combined D/I Ratio is <45% 
Loan is complete, properly approved, and funded in SAIL 

Date_____________ 

 Approved 

Employee Number___________________________________ 

 Denied 

Employee Signature__________________________________