©2015 Forms Group, All Rights Reserved


State Bank of Alcester
Credit Card Application

Privacy Policy:
The State Bank of Alcester
Privacy Policy protects the privacy of your personally-identifying information that you provide the bank online. By submitting the application, you agree that you have read and understand the Privacy Policy.

Credit Card Rates and Fees:
The State Bank of Alcester credit card rates and fees can be found at www.statebankofalcester.com/creditcard-fees. By submitting the application, you agree that you have read and understand the Credit Card Rates and Fees.

At least one applicant must be 18 years or older and must reside in South Dakota, Southwest Minnesota, Northwest Iowa or Northeast Nebraska. If you reside outside this area, the process will begin with the bank's evaluation of whether the bank can adequately service your needs.

Important Information about Procedures for Opening a New Account
Identification Procedures Requirements: 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, the bank will ask for your name, address, date of birth and other information that will allow the bank to identify you. The bank may also ask to see your driver's license or other identifying documents.

This loan application is for personal loans only and is NOT intended for commercial use. A valid social security number is required to apply. Please review and gather the information you will need before completing this form.

Security Notice:
You should ONLY fill out this Application online if you are using a browser with the latest security enhancements. If you don't have the latest version, download a copy now.

Instructions:
1. Complete Application and click "Submit Application" or fax it to (605) 934-2515.
2. To safeguard your privacy, QUIT your browser and restart it again after using this form. This form is NOT saved in your computer's memory when you quit your browser.
3. The bank will contact you after reviewing your application. You may also be requested to provide photocopies of your Social Security card, driver's license or other documentation.


Card Card Request
Credit Limit Requested:
Credit Limit Increase Requested
Type of Application:
Individual Applicant
Joint Applicant- we intend to apply for joint credit. Initials
I'm applying for a
State Bank of Alcester Visa Credit Card
South Dakota Democratic Party Visa Credit Card (Every time you use your
Visa, the State Bank of Alcester will give a percentage of your purchase amount to
the SD Democratic Party - at no additional cost to you.)

Applicant
First Name
Middle Initial
Last Name
Date of Birth
Social Security No.
No. of Dependents
Driver's License No.
Driver's License State
Your E-mail Address
Home Phone
Best Time To Call
Work Phone
Are there any unsatisfied Judgments against you? Yes No
Have you been declared bankrupt in the last 7 years? Yes No

Nearest Relative Not Living With You
Name
Relationship
Address
Telephone #


Residence
Your Primary Residence:
Own with Mortgage Own Clear Rent Other
Present Street Address
City
State
Zip
Present Mailing Address
City
State
Zip
Years At Present Address
Your Monthly Rent or Mortgage Payment
Years At Previous Address
Your Previous Address

Employment
Employed Self-Employed Retired Unemployed Student
Your Present Employer
Phone
Street Address
City
State
Zip
Gross Monthly Salary
Your Position
Years There
You do not have to list alimony, child support or separate maintenance income unless you want us to consider it for the purposes of granting and repayment of this credit request.
Other Monthly Income
Source of Other Income
Previous Employer
(if less than 3 years at current employer)
Years at
Previous Employer
Street Address
City
State
Zip

Additional Information
Your Checking Account Number
Institution Name
Your Savings Account Number.
Institution Name
Name of Creditor
Approx. Balance
Monthly Payment
Collateral, if any
Total Amount of "Other" Monthly Payments not listed above:

Co-Applicant
First Name
Middle Initial
Last Name
Date of Birth
Social Security No.
No. of Dependents
Driver's License No.
Driver's License State
Your E-mail Address
Home Phone
Best Time To Call
Work Phone

Co-Applicant Residence
Your Primary Residence:
Own with Mortgage Own Clear Rent Other
Present Street Address
City
State
Zip
Present Mailing Address
City
State
Zip
Years At Present Address
Your Monthly Rent or Mortgage Payment
Years At Previous Address
Your Previous Address

Co-Applicant Employment
Employed Self-Employed Retired Unemployed Student
Your Present Employer
Phone
Street Address
City
State
Zip
Gross Monthly Salary
Your Position
Years There
You do not have to list alimony, child support or separate maintenance income unless you want us to consider it for the purposes of granting and repayment of this credit request.
Other Monthly Income
Source of Other Income
Previous Employer
(if less than 3 years at current employer)
Years at
Previous Employer
Street Address
City
State
Zip

Co-Applicant Additional Information
Your Checking Account Number
Institution Name
Your Savings Account Number.
Institution Name
Name of Creditor
Approx. Balance
Monthly Payment
Collateral, if any
Total Amount of "Other" Monthly Payments not listed above:

Transfer of Balance Request
Upon approval, I wish to transfer my present balance on the credit card account(s) listed below to my new credit card account.
Credit Card Number 1
Institution Name
Amount To Be Transferred
Initials
Credit Card Number 2 Institution Name
Amount To Be Transferred Initials
 


Applicant(s) Statement
You have completed this request for credit in consideration of State Bank of Alcester lending to you and/or others upon your guarantee. You understand that credit cards are subject to credit approval and that fees and limits may apply. You certify that all information contained herein is accurate and complete to the best of your knowledge.

You authorize State Bank of Alcester to retain property of this application, to rely on the foregoing, to check and verify your credit, employment and salary history, to secure follow up credit reports concerning your credit worthiness and to exchange information about your account with proper persons, creditors and credit bureaus.

You authorize your employer (present and future), bank and other references listed above to release and/or verify information to State Bank of Alcester at any time. You acknowledge that this application is subject to approval of credit and acceptance by State Bank of Alcester. Should your request for credit and subsequent loan be approved, you agree to give State Bank of Alcester written notice immediately upon change of your name, address, employment or any other pertinent information contained herein.

You AGREE with the above statement