ELEVATE Card Application

"*" indicates required fields

Membership Accounts

Savings*

Share Savings Account ($5 deposit required)

I am a current Member-Owner and already have a Share Savings Account

Other Accounts

Yes! I would like a checking account with ELEVATE Debit Card

Yes! I would like the ELEVATE Credit Card

Personal Info

Full Name*

First Last

Mother's Maiden Name*

U.S. Citizen?*

Yes

Social Security Number*

Please use format: xxx-xx-xxxx

Date of Birth*

Email Address*

Primary Phone*

Secondary Phone

Select your preferred language*

English

Spanish

Housing

Housing Status*

Own

Rent

Address*

Street Address City State ZIP Code

Mortgage Holder/Landlord Name*

Monthly Payment*

Move-in Date*

ELEVATE Credit Card Limit Info

ELEVATE Credit Card Limit Requested*

Employment

Current Employer*

Note the name of the employer without the use of any symbols such as the & sign.

Position/Title*

Employer's Telephone Number*

Date of Hire*

Gross Monthly Salary*

Other Income Amount (Per Month)*

Source of Other Income

Will You Have a Co-Applicant?*

Yes

Co-Applicant Agreement

Co-Applicant Info

Applicant Intends to Apply for Joint Credit*

Applicant, please place first and last initials here

Co-Applicant Intends to Apply for Joint Credit*

Co-Applicant, please place first and last initials here

Co-Applicant Name*

Co-Applicant First Name Co-Applicant Last Name

Co-Applicant Mother's Maiden Name*

Co-Applicant US Citizen*

Yes

Co-Applicant Date of Birth*

Co-Applicant SSN*

Please use format: ×××-××-××××

Co-Applicant Email Address*

Co-Applicant Primary Phone*

Co-Applicant Secondary Phone

Co-Applicant Housing

Co-Applicant Housing Status*

Own

Rent

Co-Applicant Address*

Street City State ZIP Code

Co-Applicant Mortgage Holder/Landlord*

Monthly Payment*

Co-Applicant Move-In Date*

Co-Applicant Employment

Co-Applicant Current Employer*

Note the name of the employer without the use of any symbols such as the & sign.

Co-Applicant Position/Title*

Co-Applicant Employer's Telephone Number*

Co-Applicant's Date of Hire*

Co-Applicant's Gross Monthly Salary*

Co-Applicant Other Income Amount*

Co-Applicant Source of Other Income

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Debt Protection (click for details)

This product is optional

Your purchase of Debt Protection is optional. Whether or not you purchase this product will not affect your application for credit.

Important Disclosures

We will give you additional information before you are required to pay for Debt Protection. This information will include a copy of the contract containing the terms and conditions of Debt Protection. Eligibility requirements, conditions, and exclusions.

There are eligibility requirements, conditions, and exclusions that could prevent you from receiving Debt Protection benefits. You should carefully read your Debt Protection contract for a full explanation of the terms and conditions of the Debt Protection program.

Eligibility Requirements

To be eligible to apply, I must meet the following conditions. By signing this application, I am stating that: (1) I am under age 70; (2) If applying for death or disability protection; during the last 2 years, I have not been advised of or treated for: cancer, heart attack or coronary artery disease, stroke, cirrhosis, AIDS, or any disorder of my immune system, or had any test showing evidence of antibodies to the AlDS virus (a positive HIV test); (3) if applying for disability protection: I am presently working twenty-four (24) or more hours per week.

I acknowledge and agree that: (a) I meet the eligibility requirements listed above. If it is discovered that I do not meet the eligibility requirements above, my participation in the Plan will be terminated, I will receive a refund of any fees paid, and an otherwise valid claim will be denied; (b) I have received the disclosures herein and have thoroughly read the Debt Protection Program Agreement ("Agreement"'), and agree to abide by the terms of the Agreement; (c) I authorize the Plan fees to be added to my loan each month; and (d) I understand that I may not be eligible for all benefits contained in the Plan. This document is hereby incorporated into Applicant's loan documentation as if fully set forth therein.

There are eligibility requirements, conditions, and exclusions that could prevent you from receiving benefits under the Program. See the Program Agreement for details.

PLAN CHOICES	COST per $1,000 of monthly outstanding loan balance
Plan 1: Plan #522607 Death: Cancels card balance	$0.86
Plan 2: Plan #522608 Disability: Cancels up to 12 payments	$2.10
Plan 3: Plan #522609 Death: Cancels card balance Disability: Cancels up to 12 payments	$2.96
Benefit: Death Protection cancels a maximum of $75,000. Maximums: Cancellations listed are per occurrence. Monthly cancellations are limited to $1,000 per month, and $15,000 over the term of the card, per each Protected Event and per each Protected Cardholder. *If applying for joint protection, both Cardholders must meet the eligibility requirements.*

I Elect*

Plan 1: Plan 522607

Plan 2: Plan 522608

Plan 3: Plan 522609

No Protection Selected

Please choose your election based on the information provided in the "Debt Protection" section above

Terms & Conditions

By affirming with my signature below, I authorize Notre Dame Federal Credit Union to share my/our name(s), address and the amount of the donation made by Notre Dame FCU in my name to the below listed organization. This authorization is only for the purpose stated above. Notre Dame FCU will not share any other information about your deposits, balances, income, credit employment, or other qualification factors needed to meet our credit underwriting requirements.

I wish to direct my ELEVATE Card benefit to:

Michiana ELEVATE Card Beneficiaries*

Fort Wayne, IN ELEVATE Card Beneficiaries*

Lake County, IN ELEVATE Card Beneficiaries*

Central, IN ELEVATE Card Beneficiaries*

Arizona ELEVATE Card Beneficiaries*

Michigan ELEVATE Card Beneficiaries*

By signing below, the undersigned agree to the Credit Union by-laws and the terms and conditions of any approved account, as amended from time to time, and authorize the Credit Union to verify credit and employment history by any necessary means, including preparation of a credit report by a credit reporting agency. The undersigned certify that all information provided on this Application is true and correct and that the terms on the Application apply to all accounts held by the undersigned at this Credit Union. The undersigned acknowledge receipt of the terms and conditions that apply to any approved account.

By signing below, you are affirmatively agreeing you are aware that granting a security interest is a condition for the credit card and you intend to grant a security interest. Further, by signing below, you certify that everything stated in this application is true. Your signature(s) provides authorization to your employer(s) to release any employment verification to Notre Dame FCU. You authorize Notre Dame FCU to obtain credit reports in connection with this application and for any update, increase, renewal, extension, or collection of the credit received. If this application is approved, you understand that the use of your card will constitute acknowledgment of receipt and agreement to the terms of the credit card agreement and disclosures. Your signature(s) must appear below before we can process your application. Please save the below document for your records.

Scrip Credit Card Terms & Conditions

By checking the box below and clicking submit, you acknowledge and agree to the Terms & Conditions*

I accept the Terms and Conditions

Applicant - Full Name*

Co-Applicant - Full Name*

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