Application For Credit Insurance Coverage With Premiums Payable on an Outstanding Balance Basis

CREDIT INSURANCE IS VOLUNTARY AND NOT REQUIRED IN ORDER TO OBTAIN A LOAN.

You are not required to purchase Credit Life Disability Insurance. Your decision whether to purchase Credit Insurance will not be considered in granting the loan. You can obtain Credit Insurance elsewhere if you like. The Credit Union will not charge you for the insurance or be obliged to provide the insurance unless you sign separately below. However, if you elect Credit Life and Credit Disability coverage, that coverage will apply to each Loan Account and each Visa Account you may now have or hereafter obtain through the Credit Union, unless you decline such coverage in writing.

MAXIMUM AMOUNTS

The maximum amount of Credit Insurance on the outstanding balance of each Loan or Visa Account under the Primary Insurer's accounts are shown below:

Credit Life Insurance: $75,000 per Loan or Visa Account

Credit Disability Insurance: Maximum Number of Monthly Disability Benefit Payments 48 months.

The cost of your Credit Insurance is based on the outstanding balance of each Loan or Visa Account at the end of the monthly billing period. Your costs will be:

SINGLE CREDIT LIFE INSURANCE FOR PRIMARY OR CO-APPLICANT: $.65 per $1000 outstanding balance

JOINT CREDIT LIFE INSURANCE FOR PRIMARY INSURER AND CO-APPLICANT: $1.07 per $1,000 outstanding balance

SINGLE CREDIT DISABILITY INSURANCE, FOR PRIMARY OR CO-APPLICANT: $1.74 per $1,000 outstanding balance.

JOINT CREDIT DISABILITY INSURANCE FOR PRIMARY INSURER AND CO-APPLICANT: $2.87 per $1,000 outstanding balance

These rates for Credit Insurance are subject to change by CUNA Mutual Insurance Group upon 30 days advance notice to you.

Credit Disability Insurance benefits become payable after you have been continuously Totally Disabled for 30 days, with payments made retroactive to the date you became Totally Disabled.

All Credit Insurance and benefits terminate at age 70.

To sign up for this benefit, please click on " Insurance Application" below , print out the form, sign it, and fax it to 541-683-8705 -- or bring it into a branch at your earliest convenience. We MUST receive a form including your signature before we are able to begin the insurance on your account.

Insurance Application