Converted from AXX33A.PRN - Charter Oak Federal Credit Union

Credit Card ApplicationThere are costs associated with the useof a credit card. To obtain informationabout these costs, call us toll free at____________________ or write to us atthe 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. 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, or3. 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-Applicantbox.Guarantor: Complete the Other section if you are a guarantor on an account/loan.Credit Limit Requested $APPLICANTNAME (Last - First - Initial)OTHERNAME (Last - First - Initial)CO-APPLICANT SPOUSE GUARANTORACCOUNT NUMBERSOCIAL SECURITY NUMBERACCOUNT NUMBERSOCIAL SECURITY NUMBERDRIVER'S LICENSE NUMBER/STATEEMAIL ADDRESSDRIVER'S LICENSE NUMBER/STATEEMAIL ADDRESSBIRTH DATE HOME PHONE BUSINESS PHONE/EXT.BIRTH DATE HOME PHONE BUSINESS PHONE/EXT.PRESENT ADDRESS (Street - City - State - Zip)OWNRENTLENGTH AT RESIDENCEPRESENT ADDRESS (Street - City - State - Zip)OWNRENTLENGTH AT RESIDENCEMORTGAGE/RENT OWED TO:MORTGAGE/RENT OWED TO:MORTGAGE BALANCEMONTHLY PAYMENT$ $EMPLOYMENT/INCOMENAME ANDADDRESS OFEMPLOYERINTEREST RATE%COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTYSTATE: MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)START DATENOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BEREVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.EMPLOYMENT INCOMEOTHER INCOME$_____________ Per ______________ $_____________ Per ______________MORTGAGE BALANCEMONTHLY PAYMENT$ $EMPLOYMENT/INCOMENAME ANDADDRESS OFEMPLOYERINTEREST RATE%COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTYSTATE: MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)START DATENOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BEREVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.EMPLOYMENT INCOME$_____________ Per _____________OTHER INCOME$_____________ Per _______________NETGROSSSOURCESTATE LAW NOTICES OHIO RESIDENTS ONLY: The Ohio lawsagainst discrimination require that all creditorsmake credit equally available to all creditworthy customers, and that creditreporting agencies maintain separate credit histories on each individualupon request. The Ohio Civil Rights Commission administers compliancewith this law.WISCONSIN RESIDENTS ONLY: (1) No provision of any marital propertyagreement, unilateral statement under Section 766.59, or court decreeunder Section 766.70 will adversely affect the rights of the Credit Unionunless the Credit Union is furnished a copy of the agreement, statementor decree, or has actual knowledge of its terms, before the credit isgranted or the account is opened. (2) Please sign if you are not applyingfor this account or loan with your spouse. The credit being applied for, ifgranted, will be incurred in the interest of the marriage or family of theundersigned.XSIGNATURES1. You promise that everything you have stated in this application iscorrect to the best of your knowledge. If there are any important changesyou will notify us in writing immediately. You authorize the Credit Union toobtain credit reports in connection with this application for credit and forany update, increase, renewal, extension, or collection of the creditreceived. You understand that the Credit Union will rely on the informationin this application and your credit report to make its decision. If yourequest, the Credit Union will tell you the name and address of any creditbureau from which it received a credit report on you. It is a federal crimeto willfully and deliberately provide incomplete or incorrect information onloan applications made to federal credit unions or state chartered creditunions insured by NCUA.NETGROSSSIGNATURE FOR WISCONSIN RESIDENTS ONLYSOURCEDATE2. You understand that the use of your card will constituteacknowledgment of receipt and agreement to the terms of the credit cardagreement and disclosures. You grant us a security interest in allindividual and joint share and/or deposit accounts you have with us nowand in the future to secure your credit card account. When you are indefault, you authorize us to apply the balance in these accounts to anyamounts due. Shares and deposits in an Individual Retirement Account,and any other account that would lose special tax treatment under stateor federal law if given as security, are not subject to the security interestyou have given in your shares and deposits.X(SEAL)APPLICANT'S SIGNATURE DATE OTHER SIGNATUREDATECUNA MUTUAL GROUP, 2009 ALL RIGHTS RESERVEDAXC000-eX(SEAL)

VISA ® TRANSFER BALANCE AUTHORIZATIONName: Share Account #:Visa Account #:Expiration Date:PAYEE ACCOUNT # BALANCE12345I understand that the transfer balance will be posted as a purchase to my Charter Oak Federal VisaAccount. I have provided all necessary payment stubs and return envelopes. I agree that Charter OakFederal Credit Union is not responsible for payments that are late or lost in the mail. If the balances listedexceed my Charter Oak Federal Visa available credit, the credit union may payoff the account (s) up tomy credit limit in the order they are listed and will return any unpaid accounts to me.Signature: Date:Verified By: