Credit Card Application

General Information
Will you be applying for Individual or Joint Credit?
Joint Individual
(If Joint, the co-applicant section has the same required fields as the primary applicant.)

Maritial Status: Complete marital status if the application is for:

a. Joint or secured credit, or
b. You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)
Unmarried
Married
Separated
This application is not for joint or secured credit and I do not live in the states listed above.

*Type of Card Requested

*Number of Cards Requested

*Limit Requested

Primary Applicant
*Member Number
*Last Name
*First Name
Middle Name
*Social Security Number (TIN) --
*Date of Birth //
Number of Dependents
Ages of Dependents
*Home Phone --
Work Phone -- ext.
-- ext.
Email Address

Drivers License #
Drivers License State

Mother's Maiden Name

Home Address
*Address 1
Address 2
*City
*State
*Zip -
Time at Current Residence: Years Months
Residence Type: Own Rent Other
Monthly Payment $

Previous Address
Address 1
Address 2
City
State
*Zip -
Time at Previous Residence: Years Months
Residence Type: Own Rent Other

Present Employer
Name
Phone -- ext.
Employment Status:
Full Time
Part Time
Temp
Retired
Other
Job Title
Job Start Date //
Gross Salary $ Per
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.
Other Income $ Per
Other Income Source

Previous Employer
Name
Phone -- ext.
Employment Status:
Full Time
Part Time
Temp
Retired
Other
Job Title
Job Start Date //
Job End Date //
Gross Salary $ Per

Check box if there is a Co-Applicant
Co-Applicant

Additional Information
How would you prefer to be contacted?
Home Phone
Work Phone
Mobile Phone
Email Address
Other
Special Instructions/Comments

River-Rail Federal Credit Union - Casper, Wyoming: Credit Card Application

Tabular Disclosure
Annual Percentage Rate (APR) for Purchases	VISA Platinum 7.90% - 14.90%
Other APR'S**	Cash Advance: 7.90% - 14.90% Balance Transfer: 7.90% - 14.90%
Grace Period For Purchases	25 Days
Method Of Computing The Balance For Purchases	Average Daily Balance (Including New Purchases)
Annual Fee	None
Minimum Finance Charge	None
Foreign Transaction Fee....1%◊
Over-The-Credit-Limit Fee....$18.00
Late Payment Fee....$18.00

*The ANNUAL PERCENTAGE RATE is based on certain credit-worthiness criteria
◊ OF Transaction amount.

The information about the costs of the card described in this application is accurate as of 5/2006. This information may have changed after that date. To find out what may have changes, contact the credit union.