UICCU PLATINUM APPLICATION 
Platinum Rewards Visa--------------------------------------------------------------------------------------------------------------------- 
The UICCU Platinum Rewards Visa is specifically designed for members who tend to pay off their balance each month, but are regular 
credit card users. This card gives you an opportunity to earn points just for using it. You can redeem those points for a wide variety of 
great rewards, including: • Airline Tickets• Merchandise• Hotel Nights• Event Tickets• Cash• and much more.  You’ll earn one point for 
each dollar of purchase and 1,000 points as a bonus with your first purchase.  Visit www.selectyourrewards.com/UICCU for details. 
Platinum MasterCard------------------------------------------------------------------------------------------------------------------------ 
The UICCU Platinum MasterCard is designed for members who tend to carry a balance most months, or are consolidating balances 
from high rate credit cards. This card features rates starting as low as 9.9% APR. It also features an introductory rate as low as 0% 
APR. With rates that low, what have you got to lose?    
Which card type are you applying for:  (Please Check One): 

Platinum Rewards Visa®  

or 

 Platinum MasterCard® 

CREDIT LINE REQUESTED $____________________ (Minimum credit line is $500.) 

APPLICANT INFORMATION (please print clearly and all information is required) 
Are you a citizen of the United States?    
Are you a permanent resident of the United States?   

 Yes  No 
 Yes 

 No                   Alien Registration Number (if applicable) ________________ 

_____________________________________________ 
(as you wish it to appear on the card) 
Name 

____________________ 
Date of Birth 

____________________ 
Social Security # 

____________________ 
Mother’s Maiden Name 

_____________________________________________         
Street Address 

____________________             ____________________          ____________________ 
UICCU Member Number 
How Long at Address  

Home Phone 

_________________________________________________________________________ 
City 

State 

ZIP 

____________________ 
Cell Phone 

____________________  
Email Address 

____________________________________________ 
Employer   

____________________ 
Date Employed 

____________________ 
Work Phone 

Do You  
 Rent 
 Own  
Payment $___________ 

$___________________  
Gross Annual Income 

$______________________ 
Other Gross Annual Income (Alimony, child support, or separate maintenance income need not be revealed if you do not 
wish to have it considered as a basis for repaying the obligation). 

Name:______________________________________City/State:___________________________________Phone Number_______________ 
REQUIRED:  Please list the required information of the nearest relative not living with you. 

CO APPLICANT INFORMATION (please print clearly) 

_____________________________________________ 
(as you wish it to appear on the card) 
Name 

____________________ 
Date of Birth 

____________________ 
Social Security # 

____________________ 
Mother’s Maiden Name 

_____________________________________________         
Street Address 

____________________             ____________________          ____________________ 
UICCU Member Number 
How Long at Address  

Home Phone 

____________________________________________________________________ 
City 

State 

ZIP 

____________________ 
Cell Phone 

____________________  
Email Address 

____________________________________________ 
Employer   

____________________ 
Date Employed 

____________________ 
Work Phone 

Do You  
 Rent 
 Own  
Payment $___________ 

$___________________  
Gross Annual Income 

$______________________ 
Other Gross Annual Income (Alimony, child support, or separate maintenance income need not be revealed if you do not 
wish to have it considered as a basis for repaying the obligation). 

     
 
              
  
 
                                
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Platinum Rewards Visa 

Card Type 
Interest Rate and Interest Charges 
Introductory Annual 
Percentage Rate (APR) 
for Purchases, Balance 
Transfers and Cash 
Advances 

N/A 

Platinum MasterCard 

A fixed Introductory rate of 0%-11.9% APR* shall apply for the first 
six months.  Thereafter, the APR for all outstanding indebtedness and new 
balances relating to purchase transactions shall be at the rate listed below. 

APR for purchases, 
Balance Transfers and 
Cash Advances 

How to Avoid Paying 
Interest on Purchases 

11.9 – 18.9% APR* 
Non- Variable Rate 
*Your APR is dependent on your Credit Worthiness 

9.9 – 16.9% APR* 
Non- Variable Rate 
*Your APR is dependent on your Credit Worthiness 

If the New Balance shown on this statement is paid in full by the Payment Due Date shown on this statement, no interest charge will be imposed on Current 
Cycle Purchases (which are the purchases itemized on this statement). Each cash advance under your account will be subject to an interest charge beginning 
on the date the advance is posted to your account. Interest charges will continue to accrue on your account until the entire outstanding balance is paid in full. 

Minimum Finance Charge  None 
For Credit Card Tips from 
the Federal Reserve 
Board 
Fees 
Annual Fee 
Transaction Fees 

None 

To learn more about factors to consider when applying for or using a credit card, visit the website of the Federal Reserve Board at 
http://www.federalreserve.gov/creditcard.  

Balance Transfer 
Cash Advance 
Foreign Transaction 

None (for non-UICCU balances only) 
3% or $5 whichever is greater. 
1% of each transaction in U.S. dollars 

Penalty Fees 

Late Payment 
Over-the-Credit Limit 
Returned Check Fee 

Other Fees & Charges 

Up to $15 
None 
Up to $25 
Card Replacement Fee (for any reason): $10.00 

How We Will Calculate Your Interest:  We figure the interest charge on your account by applying the periodic rate, as stated in your Account Opening Disclosures to the 
“average daily balance” of your account. To get the “average daily balance” we take the beginning balance of your account each day, add any new purchases/advances/fees, 
and subtract any unpaid interest or other finance charges and any payments or credits. This gives us the daily balance. Then, we add up all the daily balances for the billing 
cycle and divide the total by the number of days in the billing cycle. This gives us the “average daily balance.”  
Minimum Payment: The minimum monthly payment is 2% of the new balance, but at least $25.00 or the new balance if less than $25.00.  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 5/19/2011 

STATEMENT OF INTENT 

Check coverage(s) desired.  The credit union will disclose the cost of this voluntary insurance to you.  A separate insurance election 
which discloses the terms and conditions must be signed for coverage to become effective. 

___________Single Credit Disability  

___________Joint Credit Disability 

___________Single Credit Life 

 ___________Joint Credit Life 

SIGNATURE(S) 

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 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 understand that the use of your card will constitute acknowledgement of receipt and 
agreement  to  the  terms  of  the  credit  card  agreement  and  disclosures.  Visa  and/or 
MasterCard may not be used for any illegal transactions. 

___________________              ____________________ 
     Applicant Signature                             Date                                  Other Applicant Signature                     Date 

DATE 

Average Beacon 
_________ 

Line-of-Credit amount approved 
$_____________ 

DTI After 
_________% 

UDTI After 
_________% 

Unsecured Limit 
$__________ 

TUE 
$__________ 

FOR UICCU USE ONLY 

 This card is replacing an existing UICCU Credit Card (please explain here):   _______________________________________________________ 

Employee Number & Signature: ____________________________                     Approved by Employee Number:  ___________________________