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1st Credit Card Application Form

The information on this application will be processed confidentially. Please print clearly.

PERSONAL INFORMATION (Principal Applicant)

Title

Surname

MI

First Name

Date of Birth (DD/MM/YY)

Birth Place

Nationality

Print in the boxes below how you would like your name to appear on Card. Spell Last name completely. Full name must not exceed 20 spaces.

Tel: No.(home) (cellular)

(work)

Marital Status: Married No. of Dependants

Single

Divorced

Widowed

Separated

Residential Status: Home Address

Owner

Rented

With Parents

Home Address Line 2

City/State

Zip

Country

Years/Months at present Address

(if different form Home Address) Mailing Address

Address Line 2

City/State

Zip

Country

Security Information CIF Number

What is the Name of the elementary School you attended What was your dream job as a child? Email Address

PERSONAL INFORMATION (Co-applicant)

Title

Surname

MI

First Names

Date of Birth (DD/MM/YY) Birth Place

Nationality

Tel: No. (home)

(cellular)

(work)

Home Address

Home Address Line 2

City/State

Zip

Country

Years/Months at present Address

Mailing Address (if different form Home Address)

Address Line 2

City/State

Zip

Country

CREDIT REFERENCE INFORMATION

Employment/Student Status: Employer's/University Name

Unemployed

Full-Time

Part-Time

Student

Address:

Address Line 2

City/State

Zip

Country

Phone No.

Fax No.

No. of Years/Months Occupation/Field of Study:

Previous Employer

Residence

Automobile (yr.& make)

$

1.

$

2.

$

3.

$

4.

$

Total Assets

$

Liabilities

Mortgage/Rent /Contribution Co/Bank (or name of landlord)

Description/Name

Car Loan 1.Loans- Fin. Inst. 2.Loans- Other 3.Bank Credit Card 4. Other/ Hire Purchase 5.Insurance

Total Monthly Payments/Total Liabilities

Monthly Payments

Balance $

$ $ $ $ $ $ $

Banking Information

Branch: Checking Account #

Savings Account #

Other Account #'s

Gross Monthly Income

From my Employer $ Sources:

From My Co-Applicant

$ Total Monthly Income $

Other Income $

Authorizing Signature To the best of my knowledge everything that I have stated in this application is true and correct. By signing this application, I authorize you to check my credit and employment history and to answer questions about my credit experience with you. The terms set out on the back of this application are part of this Application. I am agreeing with you to everything written here and on the back of this application.

___________________ ______________ APPLICANT SIGNATURE CO-APPLICANT

______________ DATE

---------------------------------BANK USE ONLY----------------------------------------------------

CARD LIMITS ECD

USD

Card Type: Visa Classic Visa Gold Visa Corporate

Date Processed: Input Operator:

 ................
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