CONSUMER CREDIT APPLICATION —Guuccasétrprtappin)  Wisa® BANK OF EASTMAN Credit Limit Requested $ pa nelyidal/ABeOun #2 MAGNOLIA STATE BANK (4 Joint Account:       Ee IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, Federal laws require all financial institutions to obtain, verify and record information that identifies each person who opens an Account. What this means to you: When you open an Account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.                                                                                                                     Last Name First Middle Social Security Number 3 Date of Birth No. of Dependents Home Phone Cell Phone Own Rent Other Monthly Payment $ - ( ) a a a $3 Current Address City State Zip Code How Long (yrs) Os we @ | Mailing Address (if different from above) City State Zip Code How Long (yrs) BS Zs = | Previous Address (if less than 2 years at present address) City State Zip Code How Long (yrs) O2¢ | 2g Employer Self Employed Work Phone Date Employed a a (Yes (No xt Be Address Position/Occupation Monthly Gross Income $ 88 as Name and Address of Previous Employer (if less than 2 years at present employer) How Long (yrs) oo Ze Source of Additional Income: Income from alimony, child support or separate Amount per Month $ g maintenance need not be revealed if it is not considered in determining creditworthiness = Nearest Relative (Not Living With You) Home Phone Relationship (_) Last Name First Middle Social Security Number et Date of Birth No. of Dependents Home Phone Cell Phone Own Rent Other Monthly Payment $ << 882 (__) ga a ©8238 | Current Address City State Zip Code How Long (yrs) a bad Geer Previous Address (if less than 2 years at present address) City State Zip Code How Long (yrs) Os z= Employer Self Employed Work Phone Date Employed Os i: (Yes No ( ~“e Address Position/Occupation Monthly Gross Income $ O_ > {Name and Address of Creditor Name under Which Account is Carried Account Number Balance Monthly Payment Se3 1. Home Mortgage/Rent Eee ase 2. Bank Credit Card/Bank Name and Address O¢=zc oO on | To add an authorized user to your Visa account, please complete the following information on the authorized user. A card will be issued to the authorized user if your account is approved. N As an applicant, you will be responsible for any charges made by the individual you authorized herein. If this is a joint account, both applicants will be jointly and severally responsible Pr a for any charges made by the authorized user. e 2 Name: Date of Birth: Social Security Number/ITIN: i Home Phone: Cell Phone: Street Address: City: State: Zip Code: z SSS ST a ”n PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING: This statement is submitted to obtain credit and I/we certify that all information herein is true and complete. I/We agree that ir inquiries may be made to verify information and that credit references or verification may be given based on inquiries from other parties. This offer is subject to the credit policies of this institution. /We 5 agree to be bound by the terms and conditions of the cardholder agreement, a copy of which will be mailed to the applicant if this application is granted, receipt of such agreement and acceptance eB of such terms to be conclusively presumed by the applicant's use. If you intend to apply for joint credit, the undersigned shall be jointly and severally liable for any and all credit extended from time to s time. We may report information about your account to the credit bureaus. Late payments, missed payments, or other defaults on your account may be reflected in your credit report. (o) X w Applicant Signature Date Co-Applicant Signature Date & 4 b Upon approval, | wish to transfer my present balance on the credit card account(s) listed below to my new credit card account. Le <f uw QD oc S| F Credit Card Account Number Amount to be transferred $ 214 oe o bo Signature a>]. x s S| Visa Account No. O Visa® Q Visa® Gold #1 QO) Visa® Platinum ~OoO 4 LU iy} Date Approved Credit Line Approved By Ew =5 ES IS All contents on this application are accurate as of November 1, 2016. This information may have changed after that date. To find out what may have changed, write to us at P.O. Box 909, Eastman, GA 31023. Bank of Eastman/Magnolia State Bank Application Nov 2016