Fill and Sign the Credit Card Application for Unsecured Open End Credit Form

Credit Card Application for Unsecured Open End Credit IMPORTANT: Read these Directions before completing this Application. Check Appropriate Box [ ] If you are applying for an individual account in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Sections A and D. [ ] If you are applying for a joint account or an account that you and another person will use, complete all sections, providing information in Section B about the joint applicant or user. [ ] If you are applying for an individual account, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete all sections to the extent possible, providing information in Section B about the person on whose alimony, support, or maintenance payments or income or assets you are relying. SECTION A. INFORMATION REGARDING APPLICANT Full Name (Last, First, Middle): __________________________________________ Birthdate: ______________________ Present Street Address : ___________________________________________  Years there: _______  City: _________________ State: ________ Zip: ____________Telephone __________ Social Security No.: _______________________ Driver's License No.: _______________________ Previous Street Address: ___________________________________________  Years there: _______  City: _________________ State: ________ Zip: ____________ Present Employer: ___________________________________________  Years there: __________ Telephone: _________________  Position or title: ________________________  Name of supervisor: ____________________________________  Employer's Address: __________________________________________________ Previous Employer:  Years there: _____________  Previous Employer's Address: ____________________________________________ Present net salary or commission: $__________ per (e.g., weekly, bi-weekly, monthly) Number of Dependents: _______ A ges: _________ Alimony, Child Support, or Separate Maintenance Income  Alimony, child support, separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Alimony, child support, separate maintenance received under: [ ] Court Order [ ] Written Agreement [ ] Oral Understanding [ ] Other income: $__________ per (e.g., weekly, bi-weekly, monthly) Source(s) of other income: _________________________________________________ _________________________________________________ __________________________________________________ Is any income listed in this Section likely to be reduced in the next two years? [ ] Yes (Explain in detail on a separate sheet.) [ ] No Have you ever received credit from us? [ ] Yes When? (date) Office: (Name of Office) Checking Account No.: ___________________________________  Institution and Branch: ______________________________________________ Savings Account No.: _____________________________________________________  Institution and Branch: _______________________________________________ Name of nearest relative not living with you: _____________________________________  Telephone: ___________________________  Relationship: ___________________________  Address: ___________________________________________________________ SECTION B. INFORMATION REGARDING JOINT APPLICANT, USER, OR OTHER PARTY (Use separate sheets if necessary.) Full Name:  Last _______________________  First __________________________  Middle _________________________ SECTION C. MARITAL STATUS Do not complete if this is an application for an individual account. Applicant:  [ ] Married  [ ] Separated  [ ] Unmarried (including single, divorced, and widowed) SECTION D. ASSET AND DEBT INFORMATION (If Section B has been completed, this section should be completed giving information about both the Applicant and Joint Applicant, User, or Other Person. Please mark Applicant-related information with an "A." If Section B was not completed, only give information about the Applicant in this section.) Description of Assets Value Subject to Debt? Name(s) of Yes/No Owner(s) Cash $____________ [ ] Yes [ ] No (List Names) Automobiles (Make, Model, Year) $____________ [ ] Yes [ ] No (List Names) Cash Value of Life Insurance (Issuer, Face Value) $____________ [ ] Yes [ ] No (List Names) Real Estate (Location, Date Acquired) $____________ [ ] Yes [ ] No (List Names) Marketable Securities (Issuer, Type, No. of Shares) $____________ [ ] Yes [ ] No (List Names) Other (List assets) $____________ [ ] Yes [ ] No (List Names) Total Assets $____________ Liabilities Rent or mortgage (include association fees) Monthly Payment $____________ Vehicle insurance (circle one): 1 3 6 9 12 month) (Name of other Creditor) Monthly Payment $____________ (Name of other Creditor) Monthly Payment $____________ Are any of the above past due? [ ] Yes (Explain in detail on a separate sheet.) [ ] No Credit References (Name and Address) (Relationship, e.g., personal or professional) Are you a co-maker, endorser, or guarantor on any loan or contract? [ ] Yes [ ] No If "yes" for whom? (name of debtor) To whom? (name of creditor) Are there any unsatisfied judgments against you? [ ] Yes [ ] No If "yes" to whom owed? (names of creditors for whom there are unsatisfied judgments) Have you been declared bankrupt in the last 14 years? [ ] Yes [ ] No If "yes" where? (place of bankruptcy) Year _________________________ Other Obligations (E.g., liability to pay alimony, child support, separate maintenance. Use separate sheet if necessary.) _______________________________________________ Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. Witness my signature this the ____ day of _____________, 2010. _____________________________ (Printed Name of Applicant) (Signature of Applicant) IMPORTANT INFORMATION REGARDING RATES, FEE, AND OTHER COST INFORMATION Interest Rates and Interest Charges 0.0% introductory APR for the first 6 months Annual Percentage Rate (APR) for Purchases After that, your APR will be 15.24, 17.24 or 19.24% based on your creditworthiness as determined at the time of account opening. This APR will vary with the market based on the Prime Rate. APR for Balance Transfers 15.24, 17.24 or 19.24% I ntroductory APR on balance transfers requested within 30 days of account opening. After that, your APR for those transactions and any other balance transfer requests, if we accept them, will be 15.24, 17.24 or 19.24% based on your creditworthiness. APR for Cash Advances 25.24% This APR will vary with the market based on the Prime Rate Penalty APR for Cash Advances and When it Applies 27.24% This APR will vary with the market based on the Prime Rate. This APR will apply to your account if you: 1) Make one or more late payments; or 2) Make a payment that is returned. How Long Will the Penalty APR Apply? If the Penalty APR is applied for any of these reasons, it will apply for at least 12 billing periods in a row, and will continue to apply until after you have made timely payments, with no returned payments, for 12 billing periods in a row. Paying Interest Your due date is at least 25 days after the close of each billing period. We will not charge you interest on purchases if you pay your entire balance by the due date each month. We will begin charging interest on cash advances and balance transfers on the transaction date. For Credit Card Tips from the Federal Reserve Board To learn more about factors to consider when applying for or using a credit card, visit the website of the Federal Reserve Board at http://www.federalreserve.gov/creditcard Fees Annual Membership Fee: $__________________ Additional Card Fee: $__________________ Transaction Fees Balance Transfer: Either $5 or 3% of the amount of each transfer, whichever is greater. Cash Advance: Either $5 or 3% of the amount of each cash advance, whichever is greater. Foreign Transaction: 2.7% of each transaction after conversion to US dollars. Penalty Fees Late Payment: $19 if balance is less than $250; $39 if balance is $250 or more Returned Payment: $ __________ How We Will Calculate Your Balance: We use a method called "average daily balance (including new purchases)." Loss of Introductory APR: We may end any Introductory APR and apply the Penalty APR if you make a late payment. Variable APRs for each billing period are based on the Prime Rate published in The Wall Street Journal 2 days before the Closing Date of the billing period. The Wall Street Journal may not publish the Prime Rate on that day. If it does not, we will use the Prime Rate from the previous day it was published. If the Prime Rate increases, variable APRs will increase. In that case, you may pay more interest and have a higher Minimum Payment Due. When the Prime Rate changes, the resulting changes to variable APRs take effect as of the first day of the billing period. Variable APRs are accurate as of 05/15/10. Optional Payment Protection Your purchase of protection under the (Name) Payment Protection Plan (hereinafter referred to as the “Program”) is voluntary and will not be considered in whether to grant credit. We will give you additional information upon receipt of your enrollment form. This information will include a copy of the (Name) Payment Protection Plan Contract (the “Contract”) which contains the terms and conditions of your protection under the Program. There are eligibility requirements, conditions, and exclusions that could prevent you from receiving benefits under the Program. You should carefully read the Contract for a full explanation of the terms and conditions of your protection under the Program. Within 30 days of receiving the Contract, you may cancel the protection and any fee paid by you will be returned. After the initial 30 days, you may cancel your protection at any time. PROGRAM FEE: The cost per $1,000 of the monthly outstanding loan balance is $2.25. If the outstanding loan balance is greater than $100,000, the rate will not be applied to the amount that exceeds $100,000. ELIGIBILITY: You are eligible for the Program if you are a borrower on the loan and under age 70 on the effective date of protection. A co-signer or guarantor is not eligible for protection. The Program protects the first two borrowers listed on the lending agreement. EFFECTIVE DATE OF PROTECTION: The effective date of protection means the later of the date you enrolled in the Program option, the date your protection under the Program is reinstated, or the date of the advance. ( Advance means each extension of credit we provide to you under a loan.) You elect (chose only one box): [ ] Loss of Life & Disability Protection [ ] No protection PROTECTED EVENTS: Loss of Life — If you die, we will cancel 100% of the loss of life amount. For each protected borrower, the loss of life amount is the lesser of the protected balance or $100,000. Disability — If you are employed full-time and become disabled, we will cancel the daily payment for each day that you are disabled beginning with the 31st day of disability; for the next 120 months or until the entire protected balance is cancelled, but not more than $120,000 per period of disability. NON-PROTECTED EVENTS: An advance is not protected by the Program if the event:  is due to the commission of a felony or caused by or results from an atomic explosion or any other release of nuclear energy (except when used solely for medical treatment);  occurs within the 6 months immediately following the effective date of protection for the advance and is related to a pre-existing condition for which you received advice, diagnosis, or treatment (including medication) within the 6 months immediately preceding the effective date of protection for the advance; or  occurs after age 70. An advance is not protected by Loss of Life protection if the event is the result of a suicide or an intentionally self-inflicted injury that occurs within the 12 months immediately following the effective date of protection for the advance. An advance is not protected by Disability protection if the event is related to normal pregnancy or due to an intentionally self-inflicted injury. Your signature means that: Your election will remain in effect, according to the terms of the Contract, unless subsequently modified. You authorize the Program fee to be added to your outstanding balance each month. You understand that your protection under the Plan is subject to the terms and conditions of the Contract. Witness my signature this the ____ day of _____________, 2010. _____________________________ (Printed Name of Applicant) (Signature of Applicant)