Personal Information:
First Name:

Middle Int: (MI)
Last Name:

Jr.; Sr:
Mother's Maiden Name:

Social Security Number:

Date of Birth:
Month
Day
Year
 

Contact Information:
Street: (This card will be mailed to this address)

City:

State:

Country:

Zip Code:

Primary Telephone Number:

Alternate Telephone Number:

Business Telephone Number:

E-Mail Address:


Permanent Address (if same as above, leave blank):
Street:

City:

State:

Country:

Zip Code:


Employment Information:
Employment Status
Branch of Service (or Name of Employer):

Length of Service (Employment): Years

Months

Rank or Position: (Military please provide rank)

ETS/EAS:

Employer Address
Street:

City:

State:

Country:

Zip Code:


Financial Information:
Personal Monthly Income:
Monthly Mortgage/Rent:
Source of other income:

Explain Other Monthly Income: (Excluding Co-Applicant's Income)

(Income received from child support, alimony, or separate maintenance need not be furnished, unless you want this income to be considered in evaluating this application.)


Co-Applicant Information:
 
Is this a joint account? Yes No
 
First Name:

Middle Int: (MI)
Last Name:

Jr.; Sr:
Social Security Number:

Date of Birth: Month Day Year 
Street: (This card will be mailed to this address)

City:

State:

Country:

Zip Code:

Employer Name:

Position:

Total Monthly
Income:


References:

Please supply 2 references who do not live with you.


Reference 1:
  Reference 2:
Name:
  Name:

Address:
  Address:

City:
  City:

State: (enter Country if outside US)
  State: (enter Country if outside US)

Zip Code:
  Zip Code:

Phone:
  Phone:

Relationship:
  Relationship:


Funding Options:
Requested Credit { Minimum amount $300 }:


SIGNATURE(S) PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING. You must be an FSNB, NA account holder (in good standing) for 4 months prior to applying. This application is submitted to obtain credit and I/we certify that all information in this application is true and complete. I/we authorize you to verify all information in this application and to obtain a credit report from one or more credit reporting agencies in connection with this application or any extension of credit. I/we also authorize you to release information to others about my/our credit history with you. I/we agree that this application will remain the property of FSNB, NA whether this application is approved or not. This application for credit is subject to the credit policies of FSNB, NA. I/we agree to maintain a deposit account relationship with FSNB, NA if credit is granted.
ALL ADVANCES ARE SECURED BY DEPOSITS, PRESENT OR FUTURE, IN FSNB, NA (FSNB, NA). IN CASE I/WE DEFAULT, FSNB, NA MAY APPLY ANY AND ALL DEPOSITS TO THE REPAYMENT OF SUMS DUE.
Signature

 x________________________
Applicant Date
Signature

 x________________________
Co-Applicant Date

PLEASE PRINT, SIGN AND RETURN TO:

FSNB, NA
Credit Card Department
P.O. Box 33009
Fort Sill, OK 73503-3009