Mutual Credit Union

m I intend to apply for individual credit m We intend to apply for joint credit m List authorized users (if any): Member Account #: Requested Credit Limit: $ Requested Card Type: m Gold m Classic X Applicant's Signature X Co-Applicant's Signature APPLICANT INFORMATION First Name Middle Initial Last Name Social Security Number Date of Birth Home Phone Cell Phone Home Address City/State/Zip m Own m Rent Name of Lender/Landlord How Long? (Years/Months) Monthly Mortgage/Rent $ Current Employer Position/Job Title Self-Employed? m Yes m No Employer Phone Length of Employment (Years/Months) Employer Address City/State/Zip Net Monthly Income $ *Other Income $ *Alimony, child support or separate maintenance income need not be revealed if you do not wish to rely on it as a basis for repaying this obligation. Are You a U.S. Citizen? m Yes m No Nearest Living Relative Relationship Phone Mother's Maiden Name Email Address CO-APPLICANT INFORMATION First Name Middle Initial Last Name Social Security Number Date of Birth Home Phone Cell Phone Home Address City/State/Zip m Own m Rent Name of Lender/Landlord How Long? (Years/Months) Monthly Mortgage/Rent $ Current Employer Position/Job Title Self-Employed? m Yes m No Employer Phone Length of Employment (Years/Months) Employer Address City/State/Zip Net Monthly Income $ *Other Income $ *Alimony, child support or separate maintenance income need not be revealed if you do not wish to rely on it as a basis for repaying this obligation. Are You a U.S. Citizen? m Yes m No Nearest Living Relative Relationship Phone Mother's Maiden Name Email Address Application Credit Card

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