Credit Limit Desired: 
CCU Account Number:

We intend to apply for joint credit? Yes or No
(Married applicants must provide information on their spouse even if
applying for individual credit.)

Notice to Married Applicant:  No provision of a marital property agreement, a unilateral statement under Wis. Stat. sec. 766.59 or a court decree under Wis. Stat.sec. 766.70 adversely affects the interests of the credit union unless prior to the time the credit is extended, the credit union is furnished with a copy of the agreement, statement or decree, or has actual knowledge of the adverse provision when the obligation to the credit union is incurred.

Primary Applicant
Last Name:
First Name:
Middle Initial: Date of Birth: // mm/dd/yy
E-mail Address:
Social Security Number:
Drivers License Number: State:
Marital Status*: Married Unmarried Separated

Current Address:
City:
State: Zip: How Many Years:
If less than two years, please provide previous address:
Previous Address:
City:
State: Zip: How Many Years:
Home phone:
Daytime phone:

Employment Information:

Employer Name:
Address:
Job Hire Date: / Month/Year
Emp phone number:
Gross monthly income:
Job Title:
Other Income:
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.  If revealed, it is being received under:
court order            written agreement            oral agreement


Joint Applicant:
(Married applicants must provide information on their spouse even if applying for individual credit.)

Last Name:
First Name:
Middle Initial:
Date of Birth: // mm/dd/yy
Social Security Number:
Drivers License Number: State:
Address:
City:
State: Zip: How Many Years:
Home phone:
Daytime phone:

Employment Information:

Employer Name:
Employer Address:
Job Hire Date: / Month/Year
Emp phone number:
Gross monthly income:
Job Title:
Other Income: 
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.  If revealed, it is being received under:
court order            written agreement            oral agreement

Monthly Payments (add other payments such as auto loans, alimony, child support, etc.)









Financial Assets (Checking, Savings, Stocks, Bonds, etc.)
  Name & Location                            Avg. Balance






Summary of MasterCard Account Credit Terms