P.O. Box 638 - Altus, Oklahoma 73522  CREDIT CARD APPLICATION 
 Date  Account Number  
APPLICANT INFORMATION. Married Applicants may apply for an individual loan/separate account.   
Type of Credit. Check the type of credit for which you wish to apply.  
   Individual credit -- If you are applying for individual credit, complete the Applicant section.   
   Joint credit � If you are applying for joint credit with your spouse or another person, complete the Applicant section and the Spouse/Co- Applicant section. 
You must initial here if you intend to apply for Joint Credit:  X                             X                         _ 
Spouse Information. You must also complete the Spouse section if any of the following apply:  (1) your spouse will use your account; (2) you are relying on your spouse�s income as a source of repayment; (3) you live in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI or Puerto Rico); or (4) you are an Alaska resident and are currently subject to a community property agreement or community property trust.  
 
Credit Limit Requested:  $_________________          No. of Cards: _______ Authorized User Name: __________________________ ________________ _____________  
You understand that by using the  credit card (�card�), or allowing another to use the card; you agree that such use constitutes your acknowledgment, receipt a nd agreement to the terms and 
conditions of the credit card agreement provided to you in connection with the card or credit line. Refer to the separate table that includes required credit card disclosures being furnished with 
this Application . To obtain any change in the required information since it was printed, please call us at  (866) 345 -7965  or write to us at the address stated o n this Application.  
Optional Payment Protection  � If you answer �yes� the Credit Union will disclose the cost of optional payment protection to you. A separate election that d iscloses the terms and condit ions 
must be signed for protection  to become effect ive.   Are you interested in having this loan protected?     Yes    No 
APPLICANT       SPOUSE     CO-APPLICANT   GUARANTOR  
Complete only if: (a) credit will be secured by  collateral; or (b) you live in a community property 
state; or (c) you are an Alaska resident subject to a community property agreement or community property trust: 
 MARRIED     SEPARATED      UNMARRIED (Single, Divorced, Widowed)  Complete only if: (a) credit will be secured by collateral; or (b) you live in a community property 
state; or (c) you are an Alaska resident subject to a community property agreement or 
community property trust: 
 MARRIED     SEPARATED      UNMARRIED (Single, Divorced, Widowed)  
APPLICANT NAME   SPOUSE/CO -APPLICANT NAME  
SOCIAL SECURITY NO.  DRIVER�S LICENSE NO. & STATE  BIRTH DATE   SOCIAL SECURITY NO.  DRIVER�S LICENSE NO. & STATE  BIRTH DATE  
HOME PHONE NO.  CELL PHONE * MOTHER�S MAIDEN NAME   HOME PHONE NO.  CELL PHONE * MOTHER�S MAIDEN NAME  
E-MAIL ADDRESS   E-MAIL ADDRESS  
CURRENT STREET ADDRESS (Street/City/State/Zip)  SINCE   CURRENT STREET ADDRESS (Street/City/State/Zip)  SINCE  
 DO YOU:  
 OWN     RENT    DO YOU:  
 OWN     RENT  
PERSONAL REFERENCE (Name and Address)  RELATIONSHIP   PERSONAL REFERENCE (Name and Address)  RELATIONSHIP  
PHONE NO.  PHONE NO.  
EMPLOYMENT & INCOME  You need not list income from alimony, child support or separate maintenance unless you wish it considered for purposes of gra nting this credit.  
EMPLOYER (Name and Address)  HIRE DATE   EMPLOYER (Name and Address)  HIRE DATE  
 WORK PHONE NO.    WORK PHONE NO.  
MONTHLY GROSS INCOME  
 
$ OTHER MONTHLY INCOME  
 
$ SOURCE   MONTHLY GROSS INCOME  
 
$ OTHER MONTHLY INCOME  
 
$ SOURCE  
SIGNATURES � Are you currently on active military duty?   Yes   No 
You promise that the information stated i n this Credit Card Application is true and correct to the best of your knowledge. You authorize the Credit Union to obtain cr edit reports when updating its records in connection with any 
review, increase, extension or renewal of credit, and in connection w ith any collection activities involving credit extended to you. The Credit Union may also obtain credit reports to update, increase, extend, renew or collection of the credit received by you. False or misleading statements in your application may cause any  loan to be in default. You agree that this application shall be the Credit Union�s property whether or not this application i s approved. You will notify the Credit Union in writing immediately of any changes in your name, address or employment. You unders tand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information to obtain credit. If you request, you will be provided the name and address of any credit bureau from which we received a credit  report. You understand and agree that if your application is approved, that any collateral described in any security agreement, pledge, advance disbursement voucher or similar document that may be executed, now or in the future, in connection with such credit will secure the C redit Union for repayment of funds advanced to you, subject to the terms and conditions of such security agreement, pledge, advance disbursement voucher or similar document. CONSENSUAL SECURITY INTEREST. You further acknowledge and agree that you give the Credit Union a consensual security interest in the shares you have in all individual and joint accounts you have with the Cre dit Union, now and in the future (other than those accounts that would have an adverse tax consequence if pledged as collateral), t o secure repayment of amounts you owe to the extent of any unpaid balance on your Account.  
*Permission to Contact: By providing the Credit Union with a wireless phone number (cell phone), you consent to receiving cal ls, including autodialed and prerecorded messages from the Credit Union or its third party debt collector at that number
. 
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.  OHIO RESIDENTS: The Ohio laws against discrimination requires that all creditors make credit equally available to all credit worthy 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: For any provision of any marital property agreement, court decree under WI ST � 766.70, or statement under WI ST � 766.59 to adversely affect the rights of the Credit Union, the Credit Union must be provided with a copy of the Agreement, decree or statement or have actual knowledge of its terms before any credit is  approved or account opened. Sign if you are NOT applying for this loan account with your spouse. This credit request, if approved, will be incurred in the interest of the marriage or family of the undersigned.   
Wisconsin Resident Signature ______________________________ ___________________ Date __________________  
 
X  X 
Applicant  Date   Spouse/Co -Applicant/Guarantor  Date  
Credit Union Use Only 
Approved  Yes    No, Reason _________________________________________________      No. of Cards : ______  Credit Limit:___________________   
 
 ECOA Notice and reason for Rejection sent or delivered on _________________     Loan Officer Signature__________________________________________________________Date _______________________  
Copyright 2011 ConmarSystems, Peachtree City, GA  30269 � EFORM 22018 -1 Rev. 5/20 Page 1 of 2    
   CREDIT CARD SOLICITATION DISCLOSURE  
 
IF YOU ARE APPLYING FOR A CREDIT CARD, THE FOLLOWING IS YOUR REQUIRED DISCLOSURE INFORMATION  - The information provi ded in this 
disclosure is accurate as of July 1, 2020. The information may have changed after that date. To find out what may have changed call us at (866) 345-7965 or 
write us at 2721 N Main Street, PO Box 638, Altus, OK 73522.  Before we approve you fo r a credit card, we will review your credit report, and the information 
you provide with your application to confirm that you meet the criteria for this offer. The full terms and conditions will be outlined in the Credit Card Agreement 
and Disclosure which  will be sent to you with the new card(s).  
Interest Rates and Interest Charges  
ANNUAL PERCENTAGE RATE for Purchases 8.75%-14.75%  when you open your account, based on your creditworthiness.  The APR will vary with market based on the Prime Rate.  
ANNUAL PERCENTAGE RATE for Balance Transfers 14.75%   The APR will vary with market based on the Prime Rate.  
ANNUAL PERCENTAGE RATE for Cash Advances 14.75%    The APR will vary with market based on the Prime Rate.  
Penalty APR and When it Applies  17.00% 
This APR may be applied to your account if you:  Are 60 days late in making a payment
 
                                 
How Long Will the Penalty APR Apply? If your APR's are increased for any of these reasons, 
the Penalty APR will apply until you make three (3) cons ecutive minimum payments when due.  
How to Avoid Paying Interest  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.  
Minimum Interest 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: http://www.consumerfinance.gov/learnmore
 
Fees 
Annual Fee   None 
Transaction Fees  
 Cash Advance  
 Foreign Transactions   
$5.00 or 1.00%, whichever is greater 
1% of each transaction in U.S. dollars  
Penalty Fees  
 Late Payment 
Returned P ayment  Fee  
Up to $20.00 
Up to $20.00  
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.  
Late Payment Fee                                Returned Payment Fee                      Statement Copy Fee                         Rush Fee                                         Emergency Card Replacement Fee    
Card Replacement Fee                     $20.00 or the amount of the required minimum payment, whichever is less, if you are ten (10) days or more late in making a payment.  $20.00 or the amount of the required minimum payment, whichever is less . $  5.00 $30.00 $30.00 
$10.00 
 
       
Copyright 2011 ConmarSystems, Peachtree City, GA  30269 �   EFORM 22018 -1 Rev. 5/20  
       
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