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CASH BACK REWARDS CREDIT CARD APPLICATION
Initial here if you are applying with a Co-Applicant, I intend to apply for joint credit __________________
APPLICANT
Initials
First Name Middle Initial Last name
Current Street Address Apt/Unit Number City State Zip Code
Mailing Address (if different from current address) Apt/Unit Number City State Zip Code
□ Rent
□ Own
$ $
Social Security Number Date of Birth Total Monthly Income
1
Monthly Housing Payment (If none, put $0)
Employer Occupation/Title Number of Years
E-mail Address Home Phone Cell Phone Work Phone
□ $0‒$4,999 □ $10,000‒$24,999 □ $50,000‒$99,999 □ More than $250,000
Value of your financial assets (retirement accounts, investments, etc.)
□ $5,000‒$9,999 □ $25,000‒$49,999 □ $100,000‒$249,999
Initial here if you are applying with an Applicant, I intend to apply for joint credit _______________
CO-APPLICANT
Initials
First Name Middle Initial Last name Relationship to Applicant
Current Street Address Apt/Unit Number City State Zip Code
Mailing Address (if different from current address) Apt/Unit Number City State Zip Code
Home Phone Cell Phone Work Phone
□ Rent
$
□ Own
Social Security Number Date of Birth Total Monthly Income
1
Monthly Housing Payment (If none, put $0)
Employer Occupation/Title Number of Years
Email Address
$
□ $0‒$4,999 □ $10,000‒$24,999 □ $50,000‒$99,999 □ More than $250,000
Value of your financial assets (retirement accounts, investments, etc.)
□ $5,000‒$9,999 □ $25,000‒$49,999 □ $100,000‒$249,999
1
Alimony, child support or separate maintenance income need not be provided if you do not wish it to be considered as a basis for repaying this obligation.
MARITAL STATUS
Complete only if you
are a Wisconsin resident.
_________________________________________________________________
Name Relationship to Applicant
Applicant is responsible for charges made by the authorized user on the account.
AUTHORIZED USER
Applicant □ Married □ Unmarried □ Separated
Co-Applicant □ Married □ Unmarried □ Separated
_________________________________________________________________
Account Number Name of Creditor
_________________________________________________________________
Payment Address City State Zip
_________________________________________________________________
Amount of Transfer
$
BALANCE TRANSFER
IMPORTANT APPLICANT INFORMATION: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information
that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may
also ask to see your driver’s license or other identifying documents.
All applicants must sign. Please read carefully before signing. I/We certify that everything I/we have stated in this application and on any attachments is correct. You may keep this application whether or not it is
approved. By signing below I/we authorize you to check my/our credit and employment history and to answer questions others may ask you about my/our credit record with you. I/We understand that I/we must update
credit information at your request if my/our financial condition changes. I/We acknowledge that I/we read and agree to the terms and conditions described in the enclosed IMPORTANT DISCLOSURES. Notice of
negative information: We may report information about your account to credit bureaus. Late payments, missed payments or other defaults may be reflected in your credit report.
X _____________________________________________________________________ X _____________________________________________________________________
Applicant Signature Date Co-Applicant Signature Date
click to sign
signature
click to edit
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click to sign
signature
click to edit
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