LOAN APPLICATION (VISA SELECT AND VISA PLATINUM)

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1 LOAN APPLICATION (VISA SELECT AND VISA PLATINUM) Loan Type (e.g. vehicle, Visa, Agency Secured, etc.) Requested Loan Amount $ Variable Rate MARRIED APPLICANTS MAY APPLY FOR AN INDIVIDUAL ACCOUNT. Check One: Individual Account Joint Account with Spouse Joint Account with Other (separate applications required) Requested Term Fixed Rate Check One: (Do not complete if applying INDIVIDUALLY FOR UNSECURED CREDIT unless you live in a COMMUNITY PROPERTY STATE) Married Separated Unmarried (includes single, divorced, widowed) APPLICANT INFORMATION PLEASE PRINT IN INK Applicant Member No. Purpose Social Security No. or Tax ID No. Member Name or Entity Name (full legal name) Circle if Applicable Sr. Jr. II III Date of Birth Street Address, City, State & Zip County Driver s License No./ State / Exp. Date Home Phone Mobile Phone Mailing Address. Street, City, State & Zip (if different from address above) Address Agent No. (if applicable) Present Employer / Address Position Starting Date Business Phone Monthly Salary or Wages Other Monthly Income* Amount Source Gross: Previous Employer / Position How long? No. of Dependents Do you know of any event that may interrupt your income? Yes No Name, Relationship and Address of Nearest Relative (not living with you) Name, Relationship, and Address of Other Reference CO-APPLICANT INFORMATION Married Separated Unmarried (single, divorced, widowed) *NOTICE: 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. Attach verification if income is to be considered. Phone Number Phone Number If you are relying on another person s income or you own property with another person to be used as security, answer all questions relating to both, you and your co-applicant. Also complete all information for your spouse, even if you are applying for a credit in your own name if (1) you reside in a community property state (AZ, CA, ID, LA, NV, NM, TX, WA, WI), or (2) you are applying for a secured loan. Joint Applicant Name (full legal name) Social Security No. Date of Birth Street Address, City, State & Zip Relationship to Applicant Home Phone Present Employer / Address Monthly Gross* Mobile Phone *NOTICE: 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. Attach verification if income is to be considered. Address Position Starting Date Do you know of any event that may interrupt your income? Yes No Business Phone Driver s License No. / State / Exp. Date LIABILITIES CREDITOR S NAME BALANCE OWED MONTHLY PAYMENT Monthly Rent / Mortgage (mark one) $ $ Second Mortgage (if any) $ $ Other Mortgages (office or rentals) Rental Income $ $ Are taxes and insurance included in monthly payments? Total monthly association fees, mobile home space rent and/or maintenance fees Yes No If not, what is their total? $ $ ARE YOU A COMAKER OR Yes For whom? Balance Owed Monthly Payment GUARANTOR ON ANY LOAN? No $ $ CHILD SUPPORT AND/OR SPOUSAL SUPPORT Are you obligated to pay? Yes No Monthly Payments $ JUDGEMENT AND / OR BANKRUPTCY Have you been sued for debts? Yes No Date Have you filed or declared bankruptcy in the last 10 years? Yes No Date The information provided in this application is true and complete to the best of my/our knowledge. l/we authorize the Credit Union to gather whatever credit and employment information it considers necessary and appropriate from time to time concerning such information. If the requested credit is granted, I/we also authorize the Credit Union to give such information to others. l/ We understand that the Credit Union will consider this to be a continuing statement of financial condition and therefore agree to notify the Credit Union in writing of any material change in such financial condition. If credit is granted, l/we will be bound by the terms and conditions of the applicable Loan Agreement, Truth-In-Lending Disclosure Statement or Credit Card Agreement (which will be sent to me if my application is approved and before the first transaction is made). It is agreed this application shall remain the property of the Credit Union whether or not credit is granted. Signature of Applicant Date Signature of Co-applicant Date Visa Rates, Fees and Over Limit request on other side. 0513

2 CONSENT We hereby give our consent to have Farmers Insurance Group Federal Credit Union obtain any and all information concerning our employment, checking and/or savings accounts, obligations and all other credit matters, which they may require in connection with our application for a loan. This form may be reproduced or photocopied and that copy shall be as effective consent as the original, which we have signed. Borrower Date Co-borrower Date I hereby certify this to be a true and correct copy of the original. By: Farmers Insurance Group Federal Credit Union Representative

3 AUTHORIZATION I/We hereby authorize Farmers Insurance Group Federal Credit Union to begin the processing of a Home Equity Loan on the property located at: This is my primary residence. This is NOT my primary residence. Initials: Unless otherwise prohibited by law or paid by the Credit Union, I/we agree to pay any third party fees, i.e. title search, appraisal fees, etc., incurred by the Credit Union in the processing of this loan, even if I/we cancel our loan request prior to its completion. I/we understand that these fees will be billed to me/us if applicable. Initials: INSURANCE COVERAGE ACKNOWLEDGEMENT I acknowledge and understand that it is my responsibility to keep the collateral, which I am financing with you, covered by insurance acceptable to the Credit Union for the term of the loan. As you requested, I will inform my insurance agent to provide the Credit Union with a Loss Payable Form 438 BFU as applicable showing Farmers Insurance Group Federal Credit Union as lienholder. Initials:

4 12345 PO BOX LOS ANGELES, CA HOME EQUITY EARLY DISCLOSURE IMPORTANT TERMS OF OUR HOME EQUITY LINE OF CREDIT PLAN This disclosure contains important information about our Home Equity Line of Credit Plan. You should read it carefully and keep a copy for your records. AVAILABILITY OF TERMS: All of the terms described below are subject to change. If these terms change (other than the annual percentage rate) and you decide, as a result, not to enter into an agreement with us, you are entitled to a refund of any fees that you pay to us or anyone else in connection with your application. SECURITY INTEREST: We will take a security interest in your home. You could lose your home if you do not meet the obligations in your agreement with us. POSSIBLE ACTIONS: We can terminate your line, require you to pay us the entire outstanding balance in one payment, and charge you certain fees, if For Wisconsin Borrowers Only: (1) you fail to make a required payment when due two times within a twelve month period, or (2) your failure to observe the terms of this plan materially impairs the condition, value or protection of, or our rights in, the property securing this plan. For All Other Borrowers: (1) you engage in fraud or material misrepresentation in connection with the plan; (2) you do not meet the repayment terms of this plan, or (3) your action or inaction adversely affects the collateral or our rights in the collateral. We can refuse to make additional extensions of credit or reduce your credit limit if (1) any reasons mentioned above exist; (2) the value of the dwelling securing the line declines significantly below its appraised value for purposes of the line; (3) we reasonably believe that you will not be able to meet the repayment requirements due to a material change in your financial circumstances; (4) you are in default of a material obligation of the agreement; (5) government action prevents us from imposing the annual percentage rate provided for in the agreement; (6) the priority of our security interest is adversely affected by government action to the extent that the value of the security interest is less than 120 percent of the credit line; (7) a regulatory agency has notified us that continued advances would constitute an unsafe and unsound business practice; (8) the maximum annual percentage rate is reached, or (9) For Wisconsin Borrowers Only: you engage in fraud or material misrepresentation in connection with this plan. MINIMUM PAYMENT REQUIREMENTS: You can obtain credit advances for 10 years. This period is called the "draw period." At our option, we may renew or extend the draw period. After the draw period ends the repayment period will begin. The length of the repayment period will be 15 years. You will be required to make monthly payments during both the draw and repayment periods. Your payment will include any amounts past due and any amount by which you have exceeded your credit limit, and all other charges. During the draw period, your payment will be a percentage of the outstanding balance each month based on the current annual percentage rate or $100.00, whichever is greater. The table shown below shows the minimum payment schedule: ANNUAL PERCENTAGE RATE % of Monthly Balance 0.00% to 12.00% 1.00% More than 12.00% to 15.00% 1.25% More than 15.00% to 18.00% 1.50% We will recalculate the payment at the start of the repayment period to repay the then outstanding balance by the end of the repayment period (15 years). Your payment will never be less than the smaller of $100.00, or the full amount that you owe. NEGATIVE AMORTIZATION: Under some circumstances during the draw period, the minimum payment will not cover the finance charges (interest) that is owed and negative amortization will occur. For instance, negative amortization would occur if the annual percentage rate increased to near or at the maximum rate. We will prevent negative amortization from occurring by increasing your payment to cover the finance charges (interest) owed. Once negative amortization ceases to be possible, the payment will return to the regular monthly payment. Additionally, the minimum payment will be recalculated at the start of the repayment period to repay all principal owed by the end of the repayment period. MINIMUM PAYMENT EXAMPLE: If you made only the minimum monthly payment and took no other credit advances it would take 10 years 8 months to pay off a credit advance of $10,000 at an ANNUAL PERCENTAGE RATE of 4.75%. During that period, you would make 120 payments of $100.00, followed by 7 payments of $ and one (1) final payment of $ FEES AND CHARGES: You must pay certain fees to third parties to open the plan. These fees generally total between $ and $1, We will provide you with an itemization of the fees you will have to pay third parties. PROPERTY INSURANCE: You must carry insurance on the property that secures this plan. If the property is located in a Special Flood Hazard Area we will require you to obtain flood insurance if it is available. The following notice is required by New York law. You are required to obtain property insurance on the property that is security for your mortgage loan. We cannot require you to obtain an insurance policy in excess of the replacement cost of the improvements on the property securing the loan. REFUNDABILITY OF FEES: If you decide not to enter into this plan within three business days of receiving this disclosure and the home equity brochure, you are entitled to a refund of any fee you may have already paid. TRANSACTION REQUIREMENTS: The minimum credit advance that you can receive is $1, for the first advance and $1, for each subsequent advance. TAX DEDUCTIBILITY: You should consult a tax advisor regarding the deductibility of interest and charges for the plan. VARIABLE RATE FEATURE: This plan has a variable rate feature during the draw period and the annual percentage rate (corresponding to the periodic rate) may change as a result. If the annual percentage rate increases, you will make more payments and a larger amount of principal may be owed at the end of the draw period. The annual percentage rate includes only interest and no other costs. The annual percentage rate is based on the value of an index. The index is the Prime Rate published in the Money Rates column of the Wall Street Journal. When a range of rates has been published the highest rate will be used. We will use the most recent index value available to us as of 30 days before the date of any annual percentage rate adjustment. To determine the annual percentage rate that will apply to your account, we add a margin to the value of the Index. The margin you receive is based on certain creditworthiness criteria. Your margin may be higher than the one used in the Historical Table. If the rate is not already rounded we then round up to the next.125%. Ask us for the current index value, margin for which you qualify and annual percentage rate. After you open a plan, rate information will be provided on periodic statements that we send you. CUNA MUTUAL GROUP, 1992, 1999, 2011 ALL RIGHTS RESERVED HELOC_WSJ_MultiStateDisclosure PAGE 1 OF 2 SPECIAL EED (C303423ED) 01/17/2012

5 RATE CHANGES: During the draw period, the annual percentage rate can change quarterly on the first day of February, May, August and November. The rate cannot increase or decrease more than 2.0 percentage points in any one year period. The maximum ANNUAL PERCENTAGE RATE that can apply is 18.0% or the maximum permitted by law, whichever is less. However, under no circumstances will your ANNUAL PERCENTAGE RATE go below 4.0% at any time during the term of the plan. At the start of the repayment period, the annual percentage rate will be set at the higher of 4.0% or index then in effect plus your margin. MAXIMUM RATE AND PAYMENT EXAMPLES: During the draw period, if you had an outstanding balance of $10,000, the minimum payment at the maximum ANNUAL PERCENTAGE RATE of 18.0% would be $ This annual percentage rate could be reached at the time of the 73 rd payment. During the repayment period, if you had an outstanding balance of $10,000, the minimum payment at the maximum ANNUAL PERCENTAGE RATE of 18.0% would be $ This annual percentage rate could be reached at the time of the 73 rd payment. HISTORICAL EXAMPLE: The following table shows how the annual percentage rate and the minimum payments for a single $10,000 credit advance would have changed based on changes in the index over the past 15 years. The index values are from the last business day of January of each year. While only one payment per year is shown, payments may have varied during each year. The table assumes that no additional credit advances were taken, that only the minimum payments were made, and that the rate remained constant during each year. It does not necessarily indicate how the index or your payments will change in the future. WALL STREET JOURNAL PRIME RATE INDEX TABLE Index Year (as of the last business day of January) (Percent) Margin (1) (Percent) ANNUAL PERCENTAGE RATE Monthly Payment (Dollars) (4) (4) (4) (4) (2) (4) (2) (4) (4) (4) (2) (4) 2007 Start of Repayment Period (3) (4) (3) (4) (3) (4) (3) (4) (3) (4) (1) This is a margin we have used recently; your margin may be different. (2) This ANNUAL PERCENTAGE RATE reflects an annual percentage rate periodic cap of 2.000% per year. (3) This ANNUAL PERCENTAGE RATE is fixed during the repayment period. (4) This payment reflects the minimum payment of $ The undersigned acknowledges receiving a copy of this document. X BorrowerA X BorrowerB CUNA MUTUAL GROUP, 1992, 1999, 2011 ALL RIGHTS RESERVED SPECIAL EED (C303423ED) 01/17/2012 HELOC_WSJ_MultiStateDisclosure PAGE 2 OF 2

6 1. Property Information TRUST DEED LOANS PRELIMINARY QUESTIONNAIRE Estimated Value $ Owner Occupied? Yes Property Type: Single Family Unit No Condominium Purchase Price/Appraisal Value: $ Latest Transaction Type: Purchase Purchase/Appraisal Date: Refinance 2. First Trust Deed Lender Loan No. Address Phone No. Balance owing $ Payment amount $ Is this a Negative Amortization loan? Yes No Is tax and insurance impounded? Yes No Is this an Interest Payment only loan? Yes No Annual taxes $ 3. Second Trust Deed (To be paid off) Lender Loan No. Address Phone No. Balance owing $ Payment amount $ Prepayment penalty? Yes No 4. Other Liens ( Give complete information. If none, so state. ) 5. Insurance Information Insurance company Annual Premiums $ Agent s Name Policy No. Phone No. Expiration Date I/We understand that the information given above must be accurate and that said information has a direct bearing on the loan approval. I/We agree to insure said property in an amount equal to the total first and second trust deed loans, or full guaranteed value, whichever is less. Borrower Date Co-Borrower Date

7 PERSONAL FINANCIAL STATEMENT As of Complete this form for (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning 20% or more of voting stock, or (4) any other person or entity providing a guaranty on the loan. Name Business Phone Fax Residence Address Home Phone Cell Phone City, State & Zip Code Business Name of Applicant / Borrower ASSETS LIABILITIES Funds on Deposit IRA or Other Retirement Accounts (Include Profit Sharing) Accounts & Notes Receivable Life Insurance - Cash Surrender Value (Describe in Section 2) Stocks & Bonds (Complete in Section 3) Real Estate (Complete in Section 4) Automobiles - Present Value Agency Contract Value Other Personal Property & Other Assets (Describe in Section 5) Accounts Payable Agency Secured Loans Installment Loans (Automobile, etc.) Loan on Life Insurance Mortgages on Real Estate (Complete in Section 4) Unpaid Taxes (Describe in Section 6) Notes Payable to Banks & Others (Describe in Section 7) Other Liabilities (Describe in Section 8) TOTAL LIABILITIES TOTAL ASSETS NET WORTH Section 1. Source of Income Salary or Commissions (monthly) Net Investment Income Real Estate Income Other Income (Describe below)* Contingent Liabilities As Endorser or Co-Maker Legal Claims & Judgments Provision for Federal Income Tax Other Special Debt Description of Other Income in Section 1. *Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income. Section 2. Life Insurance Held Give face amount and cash surrender value of policies and name of insurance company.

8 Section 3. Stocks & Bonds Use attachments if necessary. Each attachment must be identified as part of this statement and signed. Name of Securities Number of Shares Cost Market Value Quotation/Exchange Date of Quotation Total Value Section 4. Real Estate Owned (List each parcel separately) Use attachments if necessary. Each attachment must be identified as part of this statement and signed. Property A Property B Type of Property Property C Address Date Purchased Original Cost Present Market Value Name of Mortgage Holder Mortgage Account Number Mortgage Balance Amount of Payment per Month Status of Mortgage Section 5. Other Personal Property & Other Assets Describe, and if any is pledged as security, state name and address of lienholder, amount of lien, terms of payment, and if delinquent, describe delinquency. Section 6. Unpaid Taxes Describe in detail giving type, to whom payable, when due, amount and if there are any tax liens recorded. Section 7. Notes Payable to Banks & Others (Describe in detail) Section 8. Other Liabilities (Describe in detail) Signature Date Rev 01/08

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