Bank of Florence: Credit Card Application Form

Credit Card Application Form

Our State Bank of Florence MasterCard and VISA Gold Card offer a low interest rate and no annual fee. We are pleased to offer an online application for you to fill out and submit to us. After we receive your request, we will start our evaluation and a representative from the bank will contact you. You should be aware that we provide this service to people in Northeastern Wisconsin and the geographic area surrounding Florence County. If you are already one of our current customers, and do not live in Northeastern Wisconsin, then feel free to utilize this service. However, we do not offer this service to people nationwide or worldwide. If you would like more information or have any further questions or comments please feel free to contact us at (715) 528-4844 or email us at sbfibank@netnet.net.

Applicant Information

Marital Status

First Name

Last Name

Email Address

Social Security Number

Date of Birth

Place of Birth

Are you a U.S. Citizen?

Yes No

Street Address

City

State

Zip Code

Home Phone Number

Years at this Residence

Employer

Occupation

Salary

Per

Work Phone Number

Length of Employment

Years Months

Other Income (per month)

Sources of other Income

Contingent Liabilities

Do you have any contingent liabilities? If yes, give details:

Are you an endorser, guarantor or co-maker for others? If yes, please list creditor's name, borrower's name and account number:

Any judgment, bankruptcy, garnishment, legal proceedings against you? If yes, list type of proceeding and date:

Are any assets pledged? If yes, please list type of proceeding and date:

Use the box below to list any additional information or requests:

I acknowledge that I have made this application with the intent that The Bank should rely upon the information contained herein in granting the credit requested. I understand that, if the requested information is granted, The Bank may report information concerning the credit to consumer reporting agencies and to others. I affirm that my answers are complete and true and authorize The Bank to verify or obtain any information concerning them. Upon The Bank's request, I further authorize any firm or individual from whom I may have obtained or requested credit, to furnish the details of that transaction. I also agree to provide current financial information upon request, in a form that is acceptable.

Member FDIC

Equal Housing Lender

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