l SECURED other sources FOR HOW LONG PAYMENT DATE DESIRED WANT TO REPAY l MONTHLY l SECTION A - INDIVIDUAL APPLICANT INFORMATION

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1 AMOUNT REQUESTED NAME (Last, First, Middle) CREDIT APPLICATION IMPORTANT APPLICANT INFORMATION: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law. TYPE OF CREDIT REQUESTED FOR CREDITOR USE IMPORTANT: Check ( ) the appropriate boxes below and complete the applicable sections. DATE CLASS NO. l INDIVIDUAL CREDIT - relying solely on my income or assets l SECURED ACCOUNT NO. l INDIVIDUAL CREDIT - relying on my income or assets as well as income or assets from l UNSECURED other sources APPROVED l BY l JOINT CREDIT - We intend to apply for joint credit. (initials) DECLINED l BY FOR PAYMENT DATE DESIRED WANT TO REPAY l MONTHLY l SECTION A - INDIVIDUAL APPLICANT INFORMATION PROCEEDS OF LOAN TO BE USED FOR: BIRTHDATE TELEPHONE NO. DRIVER'S LICENSE NO. SOCIAL SECURITY NO. NO. DEPENDENTS AGES OF DEPENDENTS ADDRESS (Street, City, State & Zip) PREVIOUS ADDRESS (Street, City, State & Zip) (Complete if less than 3 years at present address) EMPLOYER (Company Name & Address) COUNTY COUNTY Do you l own or l rent? Did you l own orl rent? BUSINESS PHONE Ext. POSITION OR TITLE PREVIOUS EMPLOYER (Company Name & Address) SALARY PER MONTH GROSS: NET: NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU RELATIONSHIP TELEPHONE NO. (Include Area Code) 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. Alimony, child support, separate maintenance received under: l Court Order l Written Agreement l Oral Understanding SOURCES OF OTHER INCOME Is any income listed in this Section likely to be reduced before the credit request is paid off? l No l Yes (Explain) AMOUNT PER MONTH Have you previously received credit from us? l No l Yes - When? SECTION B - JOINT APPLICANT OR OTHER PARTY INFORMATION Complete only if: for joint credit, for individual credit relying on income or assets from other sources, or applicant is married and resides in a community property state. NAME (Last, First, Middle) BIRTHDATE TELEPHONE NO. DRIVER'S LICENSE NO. SOCIAL SECURITY NO. NO. DEPENDENTS AGES OF DEPENDENTS RELATIONSHIP TO APPLICANT (If Any) PRESENT ADDRESS (Street, City, State & Zip) EMPLOYER (Company Name & Address) BUSINESS PHONE Ext. POSITION OR TITLE PREVIOUS EMPLOYER (Company Name & Address) SALARY PER MONTH GROSS: NET: 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. Alimony, child support, separate maintenance received under: l Court Order l Written Agreement l Oral Understanding SOURCES OF OTHER INCOME Is any income listed in this Section likely to be reduced before the credit requested is paid off? l No l Yes (Explain) AMOUNT PER MONTH Has Joint Applicant or Other Party ever received credit from us? l No l Yes - When? Credit Application VMP, Bankers Systems* Wolters Kluwer Financial Services 1986, Initials: UCA 2/9/2007 VMPC148 (0612) Page 1 of 3

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5 Military Lending Act Statement Federal law provides important protections to members of the Armed Forces and their dependents relating to extensions of consumer credit. In general, the cost of consumer credit to a member of the Armed Forces and his or her dependent may not exceed an annual percentage rate of 36 percent. This rate must include, as applicable to the credit transaction or account: The costs associated with credit insurance premiums; fees for ancillary products sold in connection with the credit transaction; any application fee charged (other than certain application fees for specified credit transactions or accounts); and any participation fee charged (other than certain participation fees for a credit card account). To hear this statement read to you, please call , and choose option number five.