FSNB | Credit Card Application

Credit Card Application

PERSONAL INFORMATION

First Name

Middle Initial

Last Name

Mothers Maiden Name

SOCIAL SECURITY

XXX

XXXX

DATE OF BIRTH

CONTACT INFORMATION

Street

City

State

Country

Zip Code

Primary Phone Number

Alternate Phone Number

Business Phone Number

Email Address

PERMANENT ADDRESS (if same as above, leave blank):

Street

City

State

Country

Zip Code

EMPLOYMENT INFORMATION

Employment Status

Branch of Service (name of employer)

Length of Service (Employment)

Years

Months

Rank or Position (Military please provide rank)

ETS/EAS

Employer Address

City

State

Country

Zip Code

FINANCIAL INFORMATION

Personal Monthly Income $

Monthly Mortgage/Rent $

Source of Income

Explain Other Monthly Income: (Excluding Co-Applicant's Income) (Income received from child support, alimony, or separate maintenance need not be furnished.)

CO-APPLICANT INFORMATION

Is this a joint account?

YES

First Name

Middle Initial

Last Name

Social Security

XXX

XXXX

Date of Birth

Street (This card will be mailed to this address)

City

State

Country

Zip Code

Employer Name

Position

Total Monthly Income $

PLEASE SUPPLY 2 REFERENCES WHO DO NOT LIVE WITH YOU

Name

Address

City

State

Zip Code

Phone

Relationship

PLEASE SUPPLY 2 REFERENCES WHO DO NOT LIVE WITH YOU

Name

Address

City

State

Zip Code

Phone

Relationship

FUNDING OPTIONS

Requested Credit (Minimum Amount $300)

SIGNATURE(S) PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING. You must be an FSNB, NA account holder (in good standing) for 4 months prior to applying. This application is submitted to obtain credit and I/we certify that all information in this application is true and complete. I/we authorize you to verify all information in this application and to obtain a credit report from one or more credit reporting agencies in connection with this application or any extension of credit. I/we also authorize you to release information to others about my/our credit history with you. I/we agree that this application will remain the property of FSNB, NA whether this application is approved or not. This application for credit is subject to the credit policies of FSNB, NA. I/we agree to maintain a deposit account relationship with FSNB, NA if credit is granted.
ALL ADVANCES ARE SECURED BY DEPOSITS, PRESENT OR FUTURE, IN FSNB, NA (FSNB, NA). IN CASE I/WE DEFAULT, FSNB, NA MAY APPLY ANY AND ALL DEPOSITS TO THE REPAYMENT OF SUMS DUE.

Signature

x______________________

Signature

x______________________

Date

_______________________

I have read and agree to the terms of service

PLEASE PRINT, SIGN AND RETURN TO:
FSNB, NA
Credit Card Department
P.O. Box 33009
Fort Sill, OK 73503-3009