Loan Application Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself and the Co-Applicant section about your spouse if: 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 Co-Applicant section to the extent possible about the person on whose payments you are relying. If you are applying for Joint Credit with another person, complete the Applicant and Co-Applicant sections. Your two most recent paystubs are required. Please fax them to (203) 375-2186 once you have submitted the application. Type And Amount Of Credit You're Requesting Is this your first loan from us? Type of Credit Loan Type YesNo IndividualJoint Boat Computer Debt Consolidation Line of Credit Home Equity Motorcycle New Auto Recreation Vehicle Used Auto Vacation VISA Credit Card Other Approximate Time to Repay Amount/Credit Limit Requested Years Months Pay Periods Weeks $ Security Offered (For secured credit only, not applicable to credit cards. For Credit Cards, see Disclosure Table) Payment Protection Coverage (Check If Desired) Check coverage(s) desired. We will disclose the cost of this Payment Protection Insurance - Credit Disability and Credit Life - to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective. Do you want your loan protected for you and your family if you become disabled? YesNo Do you want your loan protected for you and your family in the event of your death? YesNo Tell Us About Yourself Applicant Last Name First Name M.I. SSN/TIN Address City State ZIP Code Years There Own or Rent? CU Account # OwnRent Home Phone Work Phone Cell Phone Email Address Birthdate (mm/dd/yyyy) Driver's License # State Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state MarriedSeparatedUnmarried Co-Applicant Last Name First Name M.I. SSN/TIN Address City State ZIP Code Years There Own or Rent? CU Account # OwnRent Home Phone Work Phone Cell Phone Email Address Birthdate (mm/dd/yyyy) Driver's License # State Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state MarriedSeparatedUnmarried Debts Applicant Mortgage/Rent owed to Balance Owed $ Monthly Payment Current APR $ % Person Responsible for Payment Co-Applicant Mortgage/Rent owed to Balance Owed $ Monthly Payment Current APR $ % Person Responsible for Payment Income Applicant Employer Position How Long? Gross Income $ Income Time Unit AnnualMonthlyBi-weeklyWeekly Co-Applicant Employer Position How Long? Gross Income $ Income Time Unit AnnualMonthlyBi-weeklyWeekly Required VISA Disclosure Information Annual percentage rate (APR) for purchases: 12.90% Grace period for repayment of the balance purchases: 25 days Method of computing the balance for purchases: Average Daily Balance (including new purchases and cash advances) Non-sufficient funds check fee: $27.00 Annual Fee: None Minimum Finance Charge: Periodic rate of 1.0750% per month Late payment fee: $15.00 Card replacement fee: $10.00 This information is accurate as of 1/1/2014 and is subject to change after that date. Please contact the credit union for any changes to this information. Application Submission You promise that everything you have stated in this request is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You also agree to notify us of any change in your name, address or employment within a reasonable time thereafter. You authorize the credit union to obtain credit reports in connection with this request. 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. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on requests made to Federal Credit Unions or State Chartered Credit Unions insured by the NCUA. You understand that the credit union will rely on the information in the request and your credit report to make its decision. By signing below, you agree to the terms of the Credit Card Agreement which will be sent with the card and you agree to pay all charges incurred in accordance with the terms of that Agreement. Please enter the security code below