Interest Rates and Interest Charges 
Annual Percentage Rate (APR) for 
Purchases 

APR for Balance Transfers 

APR for Cash Advances 

Penalty APR and When it Applies 

APPLICATION AND SOLICITATION DISCLOSURE 

8.75%, 11.75%, or 15.75% when you open your
account, based on your creditworthiness. This APR will vary with
the market based on the Prime Rate. 
11.75%, 15.75%, or 18.00% when you open your account, based on 
your creditworthiness. This APR will vary with the market based on the 
Prime Rate. 
11.75%, 15.75%, or 18.00% when you open your account, based on 
your creditworthiness. This APR will vary with the market based on the 
Prime Rate. 
18.00%

This APR may be applied to your account if you:

- Make a late payment
- Make a payment that is returned

How Long Will the Penalty APR Apply? If your APRs are increased 
for these reasons, the Penalty APR will apply until you make six (6) 
consecutive minimum payments when due.

How to Avoid Paying Interest on Purchases  Your due date is at least 25 days after the close of each billing cycle. 

For Credit Card Tips from the Consumer 
Financial Protection Bureau 

Fees 
Transaction Fees 
- Foreign Transaction Fee
Penalty Fees 
- Late Payment Fee
- Returned Payment Fee

We will not charge you any interest on purchases if you pay your entire 
balance by the due date each month.
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. 

3.00% of each transaction in U.S. dollars

Up to $27.00
Up to $27.00

How We Will Calculate Your Balance: We use a method called “average daily balance (including new purchases).” 

Application of Penalty APR: Your APR may be increased to the disclosed Penalty APR if you are 60 days late in making 
a payment or make a payment that is returned. If your APRs are increased for this reason, the Penalty APR will apply until 
you make six (6) consecutive minimum payments when due. 

Effective Date:  
The information about the costs of the card described in this application is accurate as of April 1, 2018.
This information may have changed after that date. To find out what may have changed, contact the Credit Union. 

OTHER DISCLOSURES 

Late Payment Fee

Returned Payment Fee

Document Copy Fee
Emergency Card Replacement Fee
Card Replacement Fee

Up to $27.00 or the amount of the required minimum payment, 
whichever is less, if your payment has not been received by the third 
calendar day of the month following the date that your payment is due.
Up to $27.00 or the amount of the required minimum payment, 
whichever is less.
$5.00
$85.00
$7.00

©CUNA Mutual Group 2009, 10, 12 All Rights Reserved 

000000 (MXC4XX CCM003)

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 (800) 748-0451 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: You must complete the Applicant section about yourself and the Other section about your spouse if

1.
2.
3.

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)
your spouse will use the account, or
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 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

X

Credit Limit Requested $ 

Date

(Seal)

Co-Applicant
X

Date

(Seal)

PAYMENT PROTECTION

Are you interested in having your loan protected?

YES

NO

If you answer "yes", the credit union will disclose the cost to protect your loan. The protection is voluntary and does not affect your loan approval. In 
to be covered, you will need to sign a separate application that explains the terms and conditions.

order for your loan 

APPLICANT
NAME

OTHER
NAME

CO-APPLICANT/SPOUSE

GUARANTOR

OTHER

ACCOUNT NUMBER

SOCIAL SECURITY NUMBER

ACCOUNT NUMBER

SOCIAL SECURITY NUMBER

BIRTH DATE

HOME PHONE

EMAIL ADDRESS

CELL PHONE

BUSINESS PHONE/EXT.

BIRTH DATE

HOME PHONE

EMAIL ADDRESS

CELL PHONE

BUSINESS PHONE/EXT.

DRIVER’S LICENSE NUMBER/STATE

AGES OF DEPENDENTS

DRIVER’S LICENSE NUMBER/STATE

AGES OF DEPENDENTS

PRESENT  AD DRESS

OWN

RENT

PRESENT  AD DRESS

LENGTH AT RESIDENCE

OWN

RENT

LENGTH AT RESIDENCE

COMPLETE FOR JOINT CREDIT, SECUR ED CREDIT OR IF YOU LIVE IN A COMMUNITY 

COMPLETE FOR JOINT CREDIT, SECUR ED CREDIT OR IF YOU LIVE IN A COMMUNITY 

PROPERTY STATE:

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 
IF YOU DO NOT CHO

OSE TO HAVE IT CONSIDERED.

NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT 
IF YOU DO NOT CHO

OSE TO HAVE IT CONSIDERED.

EMPLOYMENT INCOME
$  

PER

TITLE/GRADE

OTHER INCOME
$

SOURCE

PER

EMPLOYMENT INCOME
$  

PER

TITLE/GRADE

OTHER INCOME
$

SOURCE

PER

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

CREDITOR NAME & ACCOUNT NUMBER

CREDITOR NAME

ACCOUNT NUMBER

PRESENT BALANCE

MONTHLY PAYMENT

$

$

$

$

$

$

LIST ANY NAMES UNDER WHICH YOUR CREDIT REFERENCES AND CREDIT HISTORY CAN BE CHECKED:

OTHER INFORMATION ABOUT YOU

IF YOU ANSWER “YES” (BY CHECKING THE BOX) TO ANY QUESTION OTHER THAN #1,
EXPLAIN ON AN ATTACHED SHEET

APPLICANT

OTHER

1.

2.

3.

4.

ARE YOU A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN?

DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT 
CHAPTER 13, HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS, OR BEEN A PARTY IN A LAWSUIT?

PLAN CONFIRMED UNDER

IS YOUR INCOME LIKELY TO DECLINE IN THE NEXT TWO YEARS?

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): 

© CUNA Mutual Group 2016 All Rights Reserved

02105204-AXX00-C-1-062117 (AXX001-E)

STATE LAW NOTICE(S) 
Notice  to  Nebraska  Residents:  A  credit  agreement  must  be  in  writing  to  be  enforceable  under  Nebraska  law.  To  protect  you  and  us  from  any 
misunderstandings  or  disappointments,  any  contract,  promise,  undertaking,  or  offer  to  forebear  repayment  of  money  or  to  make  any  other  financial 
accommodation in connection with this loan of money or grant or extension of credit, or any amendment of, cancellation of, waiver of, or substitution for 
any or all of the terms or provisions of any instrument or document executed in connection with this loan of money or grant or extension of credit, must 
be in writing to be effective.

Notice to New York Residents: New York residents may contact the New York State Department of Financial Services to obtain a comparative 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 to Ohio Residents: 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.

Notice to Wisconsin Residents: (1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under 
Section 766.70 will adversely affect the rights of the Credit Union 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.

Signature for Wisconsin Residents Only

X

Date

(Seal)

CONSENSUAL SECURITY INTEREST
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. Shares and deposits in an IRA or 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. You may withdraw these other shares 
unless you are in default. When you are in default, you authorize us to apply the balance in these accounts to any amounts due. For example, 
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.

By signing or otherwise authenticating below, you are affirmatively agreeing that you are aware that granting a security interest is a condition 
for  the  credit  card  and  you  intend  to  grant  a  security  interest.  You  acknowledge  and  agree  that  your  pledge  does  not  apply  during  any 
periods when you are a covered borrower under the Military Lending Act. For clarity, you will not be deemed a covered borrower, and your 
pledge will apply, if: (i) you become obligated on a credit transaction or establish an account for credit when you are not a covered borrower; 
or (ii) you cease to be a covered borrower.

Security Interest Acknowledgement and Agreement

Date

Security Interest Acknowledgement and Agreement

Date

X

(Seal)

X

(Seal)

SIGNATURES
By signing or otherwise authenticating below:
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 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.
If you are applying for a credit card, you understand that the use of your card will constitute acknowledgment of receipt and agreement to the terms
of the Consumer Credit Card Agreement and Disclosure. 

2.

Applicant’s Signature

Date

Other Signature

X

(Seal)

X

Date

(Seal)

CREDIT UNION USE ONLY
DATE

APPROVED

DECLINED

(Adverse Action Notice Sent)

APPROVED 
LIMITS:

SIGNATURE
$

LINE OF CREDIT
$

OTHER
$

OTHER
$

DEBT RATIO/SCORE

BEFORE

AFTER

LOAN OFFICER COMMENTS: 

Credit Committee or Loan Officer Signatures

X

Date

(Seal)

X

Date

(Seal)

0%

APR*

ON ALL BALANCE TRANSFERS!

*APR = Annual Percentage Rate. Rates, terms, and conditions are subject to change and may vary based on creditworthiness. The current promotional APR is fixed at 0.00% on all balance transfers 
completed by 4/30/18. A 2.00% balance transfer fee is applicable. The promotional APR is good through the billing cycle ending 4/30/19. After this date the APR will be 11.75%, 15.75%, or 18.00%. As 
of 1/1/18 the current variable Cash Advance APR is 11.75%, 15.75%, or 18.00% and the current variable APR for purchases is 8.75%, 11.75%, or 15.75%. All APRs are based on your creditworthiness 
and will vary with the market based on the Prime Rate. Rates, terms and conditions are subject to change without notice. There is an International Transaction Fee of 3% in US dollars for all international 
transactions. Equal opportunity lender. All loans are subject to approval.

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