Detach and Retain Disclosure for Your Records

Inte

rest R

ate

s an

d In

tere

st Ch

arg

es

Annual Percentage Rate (APR) for Purchases

8.99%APR for Balance Transfers

8.99%

APR for Cash Advances8.99%

How to Avoid Paying Interest on

PurchasesYour due date is at least 25 days after the close of each billing cycle. W

e will not charge you any interest on purchases if you pay your

entire balance by the due date each month.

For Credit Card Tips from the

Consumer Financial Protection

Bureau

To learn more about factors to consider w

hen applying for or usinga credit card, visit the w

ebsite of the Consumer Financial Protection

Bureau at http://ww

w.consumerfinance.gov/learnm

ore.

Fe

es

Transaction Fees-

Cash Advance Fee-

Foreign Transaction FeeNone1.00%

of each multiple currency transaction in U.S. dollars

0.80% of each single currency transaction in U.S. dollars

Penalty Fees-

Late Payment Fee

- Over-the-Credit Lim

it Fee-

Returned Payment Fee

Up to $15.00Up to $15.00Up to $15.00

How W

e Will Calculate Your Balance. W

e use a method called “average daily balance (including new

purchases).”

Effective Date. The inform

ation about the costs of the card described in this application is accurate as of December 1, 2012.

This information m

ay have changed after that date. To find out what m

ay have changed, contact the Credit Union.

OTHER DISCLOSURES

Late Payment Fee

$15.00 or the amount of the required m

inimum

payment, w

hichever is less, if you are one (1) or m

ore days late in making a paym

ent.Over-the-Credit Lim

it Fee $15.00 or the am

ount of the transaction exceeding your credit limit,

whichever is less.

Returned Payment Fee

$15.00 or the amount of the required m

inimum

payment, w

hichever is less.

Document Copy Fee

$10.00Rush Fee

$35.00Em

ergency Card Replacement Fee

$150.00PIN Replacem

ent Fee $5.00

Card Replacement Fee

$15.00Unreturned Card Fee

$2.00Card Recovery Fee

$65.00

❒ Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if: (1) 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); (2) your spouse will use the account; or (3) 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 the appropriate section below. If Co-Borrower is spouse of the applicant, mark theCo-Applicant box.

Guarantor: Complete the Other section if you are a guarantor on an account/loan. ❒ Credit Limit Requested: $ _____________________

Check below to indicate the type of credit for which you are applying. Married Applicants may apply for a separate account.

Other: ■ Co-Applicant ■ Spouse ■ GuarantorApplicant

OHIO RESIDENTS ONLY: 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 com pliance with this law.

WISCONSIN RESIDENTS ONLY: (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 DATE

X

State Law Notices

1. You promise that everything you have stated in this application is correct tothe best of your knowledge. 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 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 NCUA.2. You understand that the use of your card will constitute acknowledgmentof receipt and agreement to the terms of the credit card agreement and disclosures. 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. When you are in default, you authorize us to apply the balance in these accounts to any amounts due. Shares and deposits in an Individual Retirement Account, and 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.

Signatures

(SEAL)

APPLICANT’S SIGNATURE DATE

(SEAL)

OTHER SIGNATURE DATE

XX

ACCOUNT NUMBER

Employment/Income

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.

NAME AND ADDRESS OF EMPLOYER

EMPLOYMENT INCOME

$________________ PER ________________

NET GROSS

OTHER INCOME

$________________ PER ________________

SOURCE

PRESENT ADDRESS (Street - City - State - Zip) OWN RENT

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YEARS AT THISADDRESS

NAME (Last - First - Initial)

DRIVER’S LICENSE NUMBER / STATE

COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITYPROPERTY STATE:

MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)

SOCIAL SECURITY NUMBER

E-MAIL ADDRESS

BIRTH DATE HOME PHONE BUSINESS PHONE/ EXT.

( ) ( )

MORTGAGE/RENT OWED TO:

MORTGAGE BALANCE

$

MONTHLY PAYMENT

$

STARTDATE

Employment/Income

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.

NAME AND ADDRESS OF EMPLOYER

EMPLOYMENT INCOME

$________________ PER ________________

NET GROSS

OTHER INCOME

$________________ PER ________________

SOURCE

INTEREST RATE

%

ACCOUNT NUMBER

PRESENT ADDRESS (Street - City - State - Zip) OWN RENT

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YEARS AT THISADDRESS

NAME (Last - First - Initial)

DRIVER’S LICENSE NUMBER / STATE

COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITYPROPERTY STATE:

MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)

SOCIAL SECURITY NUMBER

E-MAIL ADDRESS

BIRTH DATE HOME PHONE BUSINESS PHONE/ EXT.

( ) ( )

MORTGAGE/RENT OWED TO:

STARTDATE

MORTGAGE BALANCE

$

MONTHLY PAYMENT

$

INTEREST RATE

%

APPROVED NO. OF CARDS _____ CREDIT LIMIT $_______________________ CREDIT CARD NUMBER ____________________________________________________

DECLINED CREDIT COMMITTEE OR LOAN OFFICER SIGNATURE _____________________________________________________________________________________

FORCREDIT UNION USE ONLY

Credit Card Application

CO

LL

EG

E C

RE

DIT

UN

ION

OF

GR

EE

LE

Y2901 S

27th Ave. • G

reeley, CO

80631970-330-3900 • 1-866-870-3150Fax: 970-330-3609 • w

ww

.collegecu.org

VIS

A C

LA

SS

ICA

pp

lication

and

So

licitation

Disclo

sure

NORTHERN COLORADO CREDIT UNION2901 S 27th Ave. Greeley, CO 80631970-330-3900 • 1-866-870-3150 Fax: 970-330-3609 www.northerncoloradocu.org

A table that includes required credit card disclosures is provided with this Application. To obtain any change in the required information since it was printed, call us toll-free at 1-866-870-3150.

Interest Rates and Interest Charges

Annual Percentage Rate (APR) for Purchases 8.90%APR for Balance Transfers 8.90%APR for Cash Advances 8.90%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.

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

Transaction Fees- Cash Advance Fee- Foreign Transaction Fee

None1.00% of each multiple currency transaction in U.S. dollars 0.80% of each single currency transaction in U.S. dollars

Penalty Fees- Late Payment Fee- Over-the-Credit Limit Fee- Returned Payment Fee

Up to $15.00 Up to $15.00Up to $15.00

How We Will Calculate Your Balance. We use a method called “average daily balance (including new purchases).”

Effective Date. The information about the costs of the card described in this application is accurate as of Jun. 1, 2015. This information may have changed after that date. To find out what may have changed, contact the Credit Union.

OTHER DISCLOSURES

Late Payment Fee $15.00 or the amount of the required minimum payment, whichever is less, if you are one (1) or more days late in making a payment.

Over-the-Credit Limit Fee $15.00 or the amount of the transaction exceeding your credit limit, whichever is less.

Returned Payment Fee $15.00 or the amount of the required minimum payment, whichever is less.

Document Copy Fee $10.00Rush Fee $35.00Emergency Card Replacement Fee $150.00PIN Replacement Fee $5.00Card Replacement Fee $15.00Unreturned Card Fee $2.00Card Recovery Fee $65.00

❒In

divi

dual

Cre

dit:

You

mus

t com

plet

e the

App

lican

t sec

tion

abou

t you

rsel

f and

the O

ther

sect

ion

abou

t you

r spo

use i

f: (1

) you

live i

n or

the p

rope

rty

pled

ged

as c

olla

tera

l is

loca

ted

in a

com

mun

ity p

rope

rty s

tate

(AK,

AZ,

CA,

ID, L

A, N

M, N

V, T

X, W

A, W

I); (

2) y

our s

pous

e w

ill u

se th

e ac

coun

t; or

(3

) yo

u ar

e re

lyin

g on

you

r sp

ouse

’s in

com

e as

a b

asis

for

repa

ymen

t. If

you

are

rely

ing

on in

com

e fro

m a

limon

y, c

hild

sup

port,

or

sepa

rate

m

aint

enan

ce, c

ompl

ete

the

Othe

r sec

tion

to th

e ex

tent

pos

sibl

e ab

out t

he p

erso

n on

who

se p

aym

ents

you

are

rely

ing.

❒Jo

int

Cred

it:Ea

ch a

pplic

ant

mus

t in

divi

dual

ly c

ompl

ete

the

appr

opria

te s

ectio

n be

low

. If

Co-B

orro

wer

is s

pous

e of

the

app

lican

t, m

ark

the

Co-A

pplic

ant b

ox.

Guar

anto

r: Co

mpl

ete

the

Othe

r sec

tion

if yo

u ar

e a

guar

anto

r on

an a

ccou

nt/lo

an.

❒Cr

edit

Lim

it Re

ques

ted:

$ __

____

____

____

____

___

Ch

eck

bel

ow

to

ind

icat

e th

e ty

pe

of

cred

it fo

r w

hic

h y

ou

are

ap

ply

ing

. Mar

ried

Ap

plic

ants

may

ap

ply

fo

r a

sep

arat

e ac

cou

nt.

Oth

er:

■C

o-A

pp

lican

t

■S

po

use

■ G

uar

anto

rA

pp

lican

t

OHIO

RE

SIDE

NTS

ONLY

:Th

e Oh

io

law

s ag

ains

t di

scrim

inat

ion

requ

ire t

hat

all

cred

itors

mak

e cr

edit

equa

lly a

vaila

ble

to a

ll cr

editw

orth

y cu

stom

ers,

and

that

cred

it re

porti

ng a

genc

ies

mai

ntai

n se

para

te c

redi

t his

torie

s on

eac

h in

divi

dual

upo

nre

ques

t. Th

e Oh

io C

ivil

Righ

ts C

omm

issi

on a

dmin

iste

rs c

om pl

ianc

e w

ith th

is la

w.

WIS

CONS

IN R

ESID

ENTS

ONL

Y:(1

) No

prov

isio

n of

any m

arita

l pro

perty

agre

emen

t,un

ilate

ral s

tate

men

t und

er S

ectio

n 76

6.59

, or c

ourt

decr

ee u

nder

Sec

tion

766.

70 w

ill

adve

rsel

y af

fect

the

right

s of

the

Cred

it Un

ion

unle

ss th

e Cr

edit

Unio

n is

furn

ishe

d a

copy

of t

he a

gree

men

t, st

atem

ent o

r de

cree

, or

has

actu

al k

now

ledg

e of

its

term

s,be

fore

the

cred

it is

gra

nted

or t

he a

ccou

nt is

ope

ned.

(2) P

leas

e si

gn if

you

are

not

appl

ying

for

this

acc

ount

or

loan

with

you

r sp

ouse

. The

cre

dit b

eing

app

lied

for,

ifgr

ante

d, w

ill b

e in

curr

ed in

the

inte

rest

of t

he m

arria

ge o

r fam

ily o

f the

und

ersi

gned

.

SIG

NAT

UR

E F

OR

WIS

CO

NS

IN R

ES

IDE

NT

S O

NLY

D

ATE

X

Sta

te L

aw N

oti

ces

1.

You

prom

ise

that

eve

ryth

ing

you

have

sta

ted

in th

is a

pplic

atio

n is

cor

rect

to

the

best

of y

our k

now

ledg

e. If

ther

e ar

e an

y im

porta

nt c

hang

es y

ou w

ill n

otify

us

in w

ritin

g im

med

iate

ly. Y

ou a

utho

rize

the

Cred

it Un

ion

to o

btai

n cr

edit

repo

rts in

co

nnec

tion

with

this

app

licat

ion

for

cred

it an

d fo

r an

y up

date

, inc

reas

e, r

enew

al,

exte

nsio

n, o

r co

llect

ion

of t

he c

redi

t re

ceiv

ed.

You

unde

rsta

nd t

hat

the

Cred

it Un

ion

will

rely

on

the

info

rmat

ion

in th

is a

pplic

atio

n an

d yo

ur c

redi

t rep

ort t

o m

ake

its d

ecis

ion.

If y

ou r

eque

st, t

he C

redi

t Uni

on w

ill te

ll yo

u th

e na

me

and

addr

ess

of a

ny c

redi

t bur

eau

from

whi

ch it

rec

eive

d a

cred

it re

port

on y

ou. I

t is

a fe

dera

l cr

ime

to w

illfu

lly a

nd d

elib

erat

ely

prov

ide

inco

mpl

ete

or in

corr

ect i

nfor

mat

ion

on

loan

app

licat

ions

mad

e to

fed

eral

cre

dit

unio

ns o

r st

ate

char

tere

d cr

edit

unio

ns

insu

red

by N

CUA.

2.

You

unde

rsta

nd th

at th

e us

e of

you

r ca

rd w

ill c

onst

itute

ack

now

ledg

men

t of

rec

eipt

and

agr

eem

ent

to t

he t

erm

s of

the

cre

dit

card

agr

eem

ent

and

disc

losu

res.

You

gra

nt u

s a

secu

rity

inte

rest

in

all

indi

vidu

al a

nd j

oint

sha

re

and/

or d

epos

it ac

coun

ts y

ou h

ave

with

us

now

and

in th

e fu

ture

to s

ecur

e yo

ur

cred

it ca

rd a

ccou

nt.

Whe

n yo

u ar

e in

def

ault,

you

aut

horiz

e us

to

appl

y th

e ba

lanc

e in

the

se a

ccou

nts

to a

ny a

mou

nts

due.

Sha

res

and

depo

sits

in

an

Indi

vidu

al R

etire

men

t Acc

ount

, an

d an

y ot

her

acco

unt t

hat w

ould

lose

spe

cial

ta

x tre

atm

ent u

nder

sta

te o

r fed

eral

law

if g

iven

as

secu

rity,

are

not

sub

ject

to

the

secu

rity

inte

rest

you

hav

e gi

ven

in y

our s

hare

s an

d de

posi

ts.

Sig

nat

ure

s

AC

CO

UN

T N

UM

BE

R

Em

plo

ymen

t/In

com

e

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

.

NO

TIC

E:

ALI

MO

NY

, CH

ILD

SU

PP

OR

T, O

R S

EP

AR

AT

E M

AIN

TE

NA

NC

E IN

CO

ME

NE

ED

NO

T B

E R

EV

EA

LED

IF

YO

U D

O N

OT

CH

OO

SE

TO

HA

VE

IT

CO

NS

IDE

RE

D.

NA

ME

AN

D

AD

DR

ES

S O

F

EM

PLO

YE

R

EM

PLO

YM

EN

T I

NC

OM

E

$___

____

____

____

_ P

ER

___

____

____

____

_

NE

T

GR

OS

S

OT

HE

R I

NC

OM

E

$___

____

____

____

_ P

ER

___

____

____

____

_

SO

UR

CE

PR

ES

EN

T A

DD

RE

SS

(S

tree

t -

City

- S

tate

- Z

ip)

O

WN

R

EN

T

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. .

YE

AR

S A

T T

HIS

AD

DR

ES

S

NA

ME

(La

st -

Firs

t -

Initi

al)

DR

IVE

R’S

LIC

EN

SE

NU

MB

ER

/ S

TA

TE

CO

MP

LET

E F

OR

JO

INT

CR

ED

IT,

SE

CU

RE

D C

RE

DIT

OR

IF

YO

U L

IVE

IN

A C

OM

MU

NIT

YP

RO

PE

RT

Y S

TA

TE

:

MA

RR

IED

S

EP

AR

AT

ED

U

NM

AR

RIE

D (

Sin

gle

- D

ivor

ced

- W

idow

ed)

SO

CIA

L S

EC

UR

ITY

NU

MB

ER

E-M

AIL

AD

DR

ES

S

BIR

TH

DA

TE

H

OM

E P

HO

NE

B

US

INE

SS

PH

ON

E/

EX

T.

(

)

(

)

MO

RT

GA

GE

/RE

NT

OW

ED

TO

:

MO

RT

GA

GE

BA

LAN

CE

$

MO

NT

HLY

PA

YM

EN

T

$

ST

AR

TD

AT

EE

mp

loym

ent/

Inco

me

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

.

NO

TIC

E:

ALI

MO

NY

, CH

ILD

SU

PP

OR

T, O

R S

EP

AR

AT

E M

AIN

TE

NA

NC

E IN

CO

ME

NE

ED

NO

T B

E R

EV

EA

LED

IF

YO

U D

O N

OT

CH

OO

SE

TO

HA

VE

IT

CO

NS

IDE

RE

D.

NA

ME

AN

D

AD

DR

ES

S O

F

EM

PLO

YE

R

EM

PLO

YM

EN

T I

NC

OM

E

$___

____

____

____

_ P

ER

___

____

____

____

_

NE

T

GR

OS

S

OT

HE

R I

NC

OM

E

$___

____

____

____

_ P

ER

___

____

____

____

_

SO

UR

CE

INT

ER

ES

T R

AT

E

%

AC

CO

UN

T N

UM

BE

R

PR

ES

EN

T A

DD

RE

SS

(S

tree

t -

City

- S

tate

- Z

ip)

O

WN

R

EN

T

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. .

YE

AR

S A

T T

HIS

AD

DR

ES

S

NA

ME

(La

st -

Firs

t -

Initi

al)

DR

IVE

R’S

LIC

EN

SE

NU

MB

ER

/ S

TA

TE

CO

MP

LET

E F

OR

JO

INT

CR

ED

IT,

SE

CU

RE

D C

RE

DIT

OR

IF

YO

U L

IVE

IN

A C

OM

MU

NIT

YP

RO

PE

RT

Y S

TA

TE

:

MA

RR

IED

S

EP

AR

AT

ED

U

NM

AR

RIE

D (

Sin

gle

- D

ivor

ced

- W

idow

ed)

SO

CIA

L S

EC

UR

ITY

NU

MB

ER

E-M

AIL

AD

DR

ES

S

BIR

TH

DA

TE

H

OM

E P

HO

NE

B

US

INE

SS

PH

ON

E/

EX

T.

(

)

(

)

MO

RT

GA

GE

/RE

NT

OW

ED

TO

:

ST

AR

TD

AT

E

MO

RT

GA

GE

BA

LAN

CE

$

MO

NT

HLY

PA

YM

EN

T

$

INT

ER

ES

T R

AT

E

%

Cre

dit

Car

d A

pp

licat

ion

VISA CLASSICApplication and Solicitation Disclosure

CO

LL

EG

E C

RE

DIT

UN

ION

O

F G

RE

EL

EY

2901

S 2

7th

Ave

.G

reel

ey,

CO

806

3197

0-33

0-39

00 •

1-8

66-8

70-3

150

Fax:

970

-330

-360

9 w

ww

.col

lege

cu.o

rg

A

tab

le

that

in

clu

des

re

qu

ired

cred

it ca

rd d

iscl

osu

res

is p

rovi

ded

with

th

is A

pp

licat

ion

.To

ob

tain

any

chan

ge

in t

he

req

uir

ed i

nfo

rmat

ion

sin

ce it

was

pri

nte

d, c

all u

s to

ll-fr

eeat

1-8

66-8

70-3

150.

NORTHERN COLORADO CREDIT UNION2901 S 27th Ave. Greeley, CO 80631970-330-3900 • 1-866-870-3150 Fax: 970-330-3609 www.northerncoloradocu.org