�CUNA Mutual Group 2009, 10, 12, 16  All Rights Reserved 04400169-MXC10-C-1-060421 (MXC102-E)
APPLICATION AND
SOLICITATION
DISCLOSURE
Interest Rates and Interest Charges
Annual Percentage Rate (APR) for
PurchasesVermont Based Rate
This APR will vary  with the market based on the Prime Rate .
Standard Rate
This APR will vary  with the market based on the Prime Rate .
APR for Balance Transfers
This APR will vary  with the market based on the Prime Rate .
APR for Cash Advances
This APR will vary  with the market based on the Prime Rate .
Penalty APR and When it Applies
How to Avoid Paying Interest on
PurchasesYour 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.
Minimum Interest Charge None
For Credit Card Tips from the
Consumer Financial Protection BureauTo 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
Annual Fee
- Annual Fee None
Transaction Fees
- Balance Transfer Fee None
- Cash Advance Fee None
-Foreign Transaction Fee 1.00%  of each transaction in U.S. dollars
Penalty Fees
- Late Payment Fee Up to $20.00
How We Will Calculate Your Balance:
We use a method called "average daily balance (including new purchases)."
Vermont Based Rate: The Vermont Based APR willapply topurchases identified bythemerchant�s processing code.
This iscontingent onhow amerchant hassetuptheir processing system andifthey useaVermont state code within their
address for transactions processed by them.
Effective Date:
The information about the costs of the card described in this application is accurate as of :
This information may have changed after that date. To find out what may have changed, contact the Credit Union.
SEE NEXT PAGE for more important information about your account. �CUNA Mutual Group 2009, 10, 12, 16  All Rights Reserved 04400169-MXC10-C-1-060421 (MXC102-E)ForCalifornia Borrowers, theVermont Based Rate and Standard Rate aresecured credit cards. Credit extended
under this credit card account issecured byvarious personal property and money including, butnotlimited to:
(a)any goods you purchase with this account, (b)any shares you specifically pledge ascollateral forthis
account onaseparate Pledge ofShares, (c)allshares you have inanyindividual orjoint account with theCredit
Union excluding shares inanIndividual Retirement Account orinanyother account that would lose special tax
treatment under state orfederal law, and (d)collateral securing other loans you have with theCredit Union
excluding dwellings .
Other Fees & Disclosures:
Late Payment Fee :
Equal totherequired minimum payment ifyouarefiveormore days lateinmaking apayment. However, theFeewillnot
exceed $20.00.
Card Replacement Fee :
$10.00 .
Expedited Card Replacement Fee :
$40.00 .
Initial Request Stop Payment/Revocation of Authorization Fee :
$18.00 .
Update to Initial Request Stop Payment/Revocation of Authorization Fee :
$1.50 . �CUNA Mutual Group 2016  All Rights Reserved 04400169-AXX00-C-1-060721 (AXX002-E)
CREDIT CARD
APPLICATION
There are costs associated with the use of a credit card. Information about costs, rates and fees may be contained in disclosures provided with this
application or by calling us toll-free or collect at or writing 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 :Youmust complete theApplicant section about yourself andtheOther section about your spouse  if
1. youliveinortheproperty pledged ascollateral islocated inacommunity property state (AK, AZ,CA,ID,LA,NM, NV,TX,WA, WI)
2. yourspouse willusetheaccount, or
3. youarerelying onyour spouse's income asabasis forrepayment. Ifyouarerelying onincome from alimony, child support, orseparate
maintenance, complete theOther section totheextent possible about theperson onwhose payments youarerelying.
Joint Credit :Each Applicant must individually complete appropriate section below. IfCo-Applicant isspouse ofthe Applicant, mark theCo-Applicant
box.
Credit Card Account:  Individual  Joint
If this is an application for joint credit, Applicant and Co-Applicant each agree and acknowledge the intent to apply for joint credit (sign below):
Applicant Date
X (Seal)Co-Applicant Date
X (Seal)
 Credit Limit Requested $ If Authorized User, Name:
APPLICANT OTHERCO-APPLICANT SPOUSE GUARANTOR OTHER
NAME (Last - First - Initial) NAME (Last - First - Initial)
ACCOUNT NUMBER SOCIAL SECURITY NUMBER /INDIVIDUAL TAX ID NUMBER ACCOUNT NUMBER SOCIAL SECURITY NUMBER /INDIVIDUAL TAX ID NUMBER
BIRTH DATE EMAIL ADDRESS BIRTH DATE EMAIL ADDRESS
HOME PHONE CELL PHONE BUSINESS PHONE/EXT. HOME PHONE CELL PHONE BUSINESS PHONE/EXT.
DRIVER�S LICENSE NUMBER/STATE AGES OF DEPENDENTS DRIVER�S LICENSE NUMBER/STATE AGES OF DEPENDENTS
PRESENT ADDRESS (Street � City � State � Zip) OWN RENT PRESENT ADDRESS (Street � City � State � Zip) OWN RENT
LENGTH AT RESIDENCE LENGTH AT RESIDENCE
PREVIOUS ADDRESS (Street � City � State � Zip) OWN RENT PREVIOUS ADDRESS (Street � City � State � Zip) OWN 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:COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY
PROPERTY STATE:
MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed) MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)
EMPLOYMENT/INCOME START DATE EMPLOYMENT/INCOME START DATE
EMPLOYMENT STATUS FULL TIME PART TIME EMPLOYMENT STATUS FULL TIME PART TIME
NAME AND ADDRESS OF EMPLOYER 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
$PER OTHER INCOME
$PER EMPLOYMENT INCOME
$PER OTHER INCOME
$PER
TITLE/GRADE SOURCE TITLE/GRADE SOURCE
PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN FIVE YEARS PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN FIVE YEARS
STARTING DATE ENDING DATE STARTING DATE ENDING DATE 04400169-AXX00-C-1-060721 (AXX002-E)MILITARY : IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR? YES  NO MILITARY : IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR? YES NO
WHERE ENDING/SEPARATION DATE WHERE ENDING/SEPARATION DATE
REFERENCE REFERENCE
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
RELATIONSHIP HOME PHONE RELATIONSHIP HOME PHONE
WHAT YOU OWE
DEBTCREDITOR NAME OTHER THAN THIS CREDIT UNION
(Attach additional sheet(s) if necessary)INTEREST RATE PRESENT BALANCE MONTHLY PAYMENTOWED BY
 APPLICANT OTHER
 RENT
% $ $  FIRST MORTGAGE
(Incl. Tax & Ins.)
% $ $
% $ $
% $ $
% $ $
% $ $
% $ $
% $ $
% $ $
% $ $
% $ $
% $ $
LIST ANY NAMES UNDER WHICH YOU R CREDIT REFERENCES
AND CREDIT HISTORY CAN BE CHECKED: TOTALS $ $
WHAT YOU OWN
ASSET DESCRIPTION LIST LOCATION OF PROPERTY OR FINANCIAL INSTITUTION MARKET VALUEPLEDGED AS COLLATERAL
FOR ANOTHER LOANOWNED BY
APPLICANT OTHER
$ YES NO
$ YES NO
$ YES NO
$ YES NO
$ YES NO
$ YES NO
$ YES NO
OTHER INFORMATION ABOUT YOUIF YOU ANSWER �YES� (BY CHECKING THE BOX) TO ANY QUESTION OTHER THAN #1,
EXPLAIN ON AN ATTACHED SHEET APPLICANT OTHER
1. ARE YOU A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN?
2. DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT
PLAN CONFIRMED UNDER CHAPTER 13, HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS, OR BEEN A PARTY
IN A LAWSUIT?
3. IS YOUR INCOME LIKELY TO DECLINE IN THE NEXT TWO YEARS?
4. ARE YOU A CO-MAKER, CO-SIGNER OR GUARANTOR ON ANY LOAN NOT LISTED ABOVE?
FOR WHOM (Name of Others Obligated on Loan):
TO WHOM (Name of Creditor): 04400169-AXX00-C-1-060721 (AXX002-E)STATE LAW NOTICE (S)
Notice toNebraska Residents :Acredit agreement must beinwriting tobeenforceable under Nebraska law. Toprotect you and usfrom any
misunderstandings ordisappointments, anycontract, promise, undertaking, oroffer toforebear repayment ofmoney ortomake anyother financial
accommodation inconnection with thisloan ofmoney orgrant orextension ofcredit, oranyamendment of,cancellation of,waiver of,orsubstitution for
anyoralloftheterms orprovisions ofanyinstrument ordocument executed inconnection with thisloan ofmoney orgrant orextension ofcredit, must
be in writing to be effective.
Notice toNew York Residents :New York residents may contact theNew York State Department ofFinancial Services toobtain acomparative listing
of credit card rates, fees, and grace periods. New York State Department of Financial Services: 1-800- 342-3736 or www.dfs.ny.gov .
Notice toOhio Residents :The Ohio laws against discrimination require thatallcreditors make credit equally available toallcreditworthy customers,
andthatcredit reporting agencies maintain separate credit histories oneach individual upon request. The Ohio Civil Rights Commission administers
compliance with this law.
Notice toWisconsin Residents :(1)Noprovision ofanymarital property agreement, unilateral statement under Section 766.59, orcourt decree under
Section 766.70 willadversely affect therights oftheCredit Union unless theCredit Union isfurnished acopy oftheagreement, statement ordecree, or
hasactual knowledge ofitsterms, before thecredit isgranted ortheaccount isopened. (2)Please sign ifyouarenotapplying forthisaccount orloan
with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.
Signature for Wisconsin Residents Only Date
X (Seal)
CREDIT CARD CONSENSUAL SECURITY INTEREST
You grant usasecurity interest inallindividual and joint share and/or deposit accounts you have with usnow and inthefuture tosecure
your credit card account. Shares anddeposits inanIRAoranyother account that would lose special taxtreatment under state orfederal law
ifgiven assecurity arenotsubject tothesecurity interest youhave given inyour shares anddeposits. You may withdraw these other shares
unless youareindefault. When youareindefault, youauthorize ustoapply thebalance inthese accounts toanyamounts due. Forexample,
if you have an unpaid credit card balance, you agree we may use funds in your account(s) to pay any or all of the unpaid balance.
Bysigning orotherwise authenticating below, youareaffirmatively agreeing that youareaware thatgranting asecurity interest isacondition
for the credit card and you intend to grant a security interest .
Security Interest Acknowledgement and Agreement Date
X (Seal)Security Interest Acknowledgement and Agreement Date
X (Seal)
SIGNATURES
By signing or otherwise authenticating below:
1. You promise that everything youhave stated inthisapplication iscorrect tothebest ofyour knowledge ,and that theabove information isa
complete listing ofwhat youowe.Ifthere areanyimportant changes youwillnotify usinwriting immediately. You authorize theCredit Union to
obtain credit reports inconnection with thisapplication forcredit and foranyupdate, increase, renewal,extension,orcollectionofthecredit
receivedandforotheraccounts,products,orserviceswemayofferyouorforwhichyoumayqualify.YouunderstandthattheCredit Union will
relyontheinformation inthisapplication andyour credit report tomake itsdecision. Ifyourequest, theCredit Union willtellyouthename and
address ofanycredit bureau from which itreceived acredit report onyou. Itisacrimetowillfullyanddeliberatelyprovideincompleteorincorrect
information in this application.
2. You understand that theuseofyour card willconstitute acknowledgment ofreceipt and agreement totheterms oftheConsumer Credit Card
Agreement and Disclosure.
Applicant�s Signature Date
X (Seal)Other Signature Date
X (Seal)
CREDIT UNION USE ONLY
DATE APPROVED
DECLINEDNUMBER OF CARDS CREDIT LIMIT
$CREDIT CARD NUMBER
Signature s
Date
X (Seal)Date
X (Seal)