Citizens Bank | Credit Card Application

To apply, you must be:

18 Years of age or older

**Please note - Citizens Bank Credit cards are only available to residents of Morgan, Hendricks, Western Johnson and southern Marion counties in central Indiana.**

Credit Card Application
Joint Account Individual Account
MasterCard Visa Classic Visa Gold Requires minimum gross annual income of $35,000.00
Section A - Applicant
Last Name	First Name	Middle
Birthdate		Soc. Sec. No.
Present Address
Street Address		Number of Dependents
City	State Zip	How Long? Years Months
Driver's License Number		Driver's License State
Do you Own/Buying Rent Other		Monthly Rent or Mortgage Payment ($400)
Area Code-Home Phone (123-456-7890)
Previous Address (if less than three years at current address)
Street Number	Street Address
City	State	Zip
Present Employer	Occupation	If currently unemployed, please select one of the following categories.
How Long Years Months	Gross Monthly Salary ($16000)	Employer's Phone (123-456-7890)

Complete Information on joint account only if joint account desired.
Name		Soc. Sec. No.
Address		Relationship to Applicant
Employer	How Long	Gross Monthly Salary
Address		Position
Income from alimony, child support, or separate maintenance payments need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.
Source of Other Income	Amount of Other Income ($1000) Monthly Weekly Annually
Do you have a Checking Account? Yes, Citizens Bank Yes, other institution No	Do you have a Savings Account? Yes, Citizens Bank Yes, other institution No

Complete following information for all applicants.
Bank Name
Checking Account Number		Savings Account Number
All Debt or Obligations	Have you ever filed for bankruptcy Yes No
Creditor	Address	Purpose	Bal. Owing	Mo. Payment





Mortgage or landlord
Alimony, child support, etc.
Credit Cards


I (we) make application for a VISA or MASTERCARD and or any other card(s) issued as a result of this application. If this application is accepted and a VISA and /or MASTERCARD card(s) issued, the undersigned applicant, if any, by signing, using, or permitting another to use the VISA and/or MASTERCARD credit card(s) agree(s) that the applicant and joint applicant, if any, will be bound by the terms and conditions of the VISA and/or MASTERCARD credit card agreement, and customer payment schedule. Everything that I (we) have stated in the application is correct to the best of my (our) knowledge. I (We) understand that you will retain this application whether or not it is approved. You are authorized to check my (our) credit and employment history and to answer questions about your credit experience with me (us). I (we) understand that a periodic membership fee may be accessed.
By clicking the "Submit" button below, I the Applicant, if approved, agree to and intend to be bound by the terms and conditions of this credit card application.
Visa and Mastercard are widely accepted and widely used throughout the world. Millions of people use their cards at more than 3 million stores in 155 countries. If you have a VISA or MASTERCARD, your credit is good across the country and around the world.

CREDIT DISCLOSURE	VISA/MC	VISA GOLD
Annual Percentage Rate for Purchases	14.9%	11.9%
Grace period for repayment of balances for purchases	You have 25 days to repay your balance before a finance charge on purchases will be imposed.
Method for computing the balance for	Average Daily Balance (including new transactions)
Annual membership fee	None	None
Minimum finance charge	None	None
Transaction fee for cash advances	$2.00	$2.00
Late fee	If at least the minimum payment is not received within 10 days after payment due date, a late payment of $10.00 will be charged.
Overline fee	$10.00 shall be assessed if your balance exceeds your approved credit line by $100 during billing cycle.

The information about the costs of the card described in this application is accurate as of May, 2007, when it was created. This information may have changed after that date. To find out what may have changed please call Citizens Bank at 317-831-0110.

Complete Information on joint account only if joint account desired.

Complete following information for all applicants.