Card Choice: MasterCard Account Choice: Individual Account Joint Account
APPLICANT                     Note: All Applicable Sections Should Be Filled out Completely. If Not processing Of Your Application May Be Delayed
Last Name __________________________
First __________________________
Middle ____
Member Number________________
Social Security Number________________
Date of Birth ________________
No. of Dependents ____
Home Phone ________________
Current Address_________________________________________________________
City __________________________ State ____  
 Zip Code _____________
Own Rent Other
Employer __________________________
Self Employed Yes No
Address _________________________________________________________
Work Phone ________________
Position/Occupation __________________________
CO-APPLICANT or SPOUSE                     Complete This Section Only If CO-Applicant or Spouse is Applying For Joint Account
Last Name __________________________
First __________________________
Middle ____
Date of Birth ________________
No. of Dependents ____
Home Phone ________________
Current Address_________________________________________________________
City __________________________ State ____  
 Zip Code _____________
Own Rent Other
Employer __________________________
Self Employed Yes No
Address _________________________________________________________
Work Phone ________________
Position/Occupation __________________________
*You Need Not Furnish Alimony, Child Support or Maintenance Income Information If You Do Not Want Us To Consider It In Evaluating Your Application
CREDIT DISCLOSURES
ANNUAL PERCENTAGE RATE FOR PURCHASES ANNUAL MEMBERSHIP FEE GRACE PERIOD FOR PURCHASES METHOD OF COMPUTING THE BALANCE FOR PURCHASES LATE PAYMENT FEE OVER THE LIMIT FEE CASH ADVANCE FEE
12.90% NONE 25 DAYS AVERAGE DAILY BALANCE INCLUDING NEW PURCHASES $15.00 NONE NONE

A finance charge will be imposed on Credit Purchases only if you elect not to pay the entire New Balance shown on your monthly statement for the previous billing cycle within 25 days from the closing date of that statement. If you elect to pay the entire New Balance shown on your previous monthly statement within that 25-day period, a Finance Charge will be imposed on the unpaid average daily balance of such Credit Purchases from the previous statement closing date and on new Credit Purchases from the date of posting to your account during the current billing cycle, and will continue to accrue until the closing date of the billing cycle preceding the date on which the entire New balance is paid in full or until the date of payment if more than 25 days from the closing date. The Finance Charge for a billing cycle is computed by applying the monthly Periodic Rate to the average daily balance of Credit Purchases, which is determined by dividing the sum of the daily balances during the billing cycle by the number of days in the cycle. Each daily balance of Credit Purchases is determined by adding the outstanding unpaid balance of Credit Purchases at the beginning of the billing cycle to any new Credit Purchases posted to your account, and subtracting any payments as received and credits as posted to your account, but excluding any unpaid Finance Charges. A finance charge will be assessed on cash advances from the date of the cash advance, or the first day of the billing cycle in which the cash advance is posted, whichever is later, and will continue to accrue until payment in full is made. Cash Advances will be calculated in the same manner as explained for Credit Purchases.
SIGNATURE(S)
APPLICANTS MUST SIGN THE PLEDGE OF SHARES AS A CONDITION OF RECEIVING A SECURED MasterCard. By signing below, I/we hereby pledge and grant the Memorial Health Credit Union a security interest in the following share holdings, now held or hereafter acquired with us, to secure my/our MasterCard account. I/We authorize the credit union to apply these share holdings to pay any amount due on the account or under this agreement if I/we should default. I/We understand that for secured cards, the shares securing this card must be held by the credit union for 45 days after the account is closed.
X_______________________________________________
X_________________________________________________
Applicant Signature/Share Account                   Date
Co-applicant Signature/Share Account No.            Date
PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING: This statement is submitted to obtain credit and I/We certify that all information herein is true and complete. I/We agree that inquiries may be made to verify information and to obtain a credit history, and that credit references or verification may be given based on inquiries from other parties. This offer is subject to credit policies of this institution. I/We agree to be bound by the terms and conditions of the credit card agreement and disclosure statement, copies of which will be mailed to the applicant if this application is granted, receipt of such agreement and disclosure and acceptance of such terms to be conclusively presumed by the applicant's use of card(s). If this is a joint application, the undersigned shall be jointly and severally liable for any and all credit extended from time to time.
X_______________________________________________
X__________________________________________________
Applicant Signature/Share Account No.           Date
Co-applicant Signature/Share Account No.          Date
TRANSFER OF BALANCE REQUEST
Upon approval, I wish to transfer my present balance on the credit card account(s) listed below to my new credit card account.
Visa Account No. MasterCard Account No.
Please send a copy of your last statement(s)
Signature_____________________________
FOR CREDIT UNION ONLY
    MasterCard Account No.  
    ______________________________________________________
DATE APPROVED
 CREDIT LINE
 APPROVED BY
 DATE APPROVED
 CREDIT LINE
 APPROVED BY
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