APPLY FOR A VISA


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This Application Is Secure

This application is intended for individuals who reside in East Texas or those moving to our geographic area. If this does not apply to you, please be advised that we are not currently lending to non-customers out of our geographic area.

If you apply in error, we may automatically access your credit record. Some lenders deny credit due to excessive inquiries and submitting this application without meeting the above requirement may reflect poorly if you apply elsewhere in the near future.

CAUTION, providing false or misleading information on an application in a credit transaction could result in a violation of federal law. (18 USC Ch. 47 Section 1014)

Please Select:
 
  Visa
 Visa Gold

Request Credit Limit:

SECTION A - INFORMATION ABOUT APPLICANT
FULL NAME (Last, First, Middle)
BIRTH DATE
RESIDENTIAL PHONE NUMBER
SOCIAL SECURITY NUMBER
PRESENT ADDRESS (Street, City, State, & Zip)
HOW LONG HAVE YOU LIVED HERE
YOUR DRIVERS LICENSE NUMBER
PREVIOUS ADDRESS (Street, City, State & Zip)
HOW LONG DID YOU LIVE THERE
PRESENT EMPLOYER (Company Name, Address and Phone Number)
HOW LONG HAVE YOU WORKED HERE
YOUR POSITION OR TITLE
NAME OF SUPERVISOR
BUSINESS PHONE
PREVIOUS EMPLOYER (Company Name, Address and Phone Number)
HOW LONG DID YOU WORK THERE
GROSS SALARY PER MONTH
OTHER INCOME*

SOURCE OF OTHER INCOME
*Alimony, child support, or separate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Alimony, child support, separate maintenance received under: (Please Place any applicable "Yes" answer in appropriate box)
Court Order...........:
Written Agreement:
Oral Understanding:
NUMBER OF DEPENDENTS

HAVE YOU EVER HAD A CAR OR OTHER MERCHANDISE REPOSSESSED? (Please Answer Yes or No)
IF YOU ANSWERED YES TO THE QUESTION ABOVE, PLEASE STATE WHEN THIS OCCURRED
HAVE YOU EVER RECEIVED CREDIT FROM US? (Please Answer Yes or No)
IF YOU ANSWERED YES TO THE QUESTION ABOVE, PLEASE STATE WHEN THIS OCCURRED
HAVE YOU EVER FILED BANKRUPTCY? (Please Answer Yes or No)
IF YOU ANSWERED YES TO THE QUESTION ABOVE, PLEASE STATE WHEN THIS OCCURRED
NAME, ADDRESS AND PHONE NUMBER OF NEAREST RELATIVE (Not living with you)
SECTION B - INFORMATION ABOUT YOUR BANK
YOUR BANK NAME AND ADDRESS
CHECKING ACCOUNT NUMBER / NAME LISTED
SAVINGS ACCOUNT NUMBER / NAME LISTED

SECTION C - CREDIT INFORMATION
AUTOMOBILE FINANCED BY:

MONTHLY PAYMENT AMOUNT:
OTHER ITEMS FINANCED BY:

MONTHLY PAYMENT AMOUNT:

RENT OR OWN:

MONTHLY RENT PAYMENT:
HOME FINANCED BY:

MONTHLY PAYMENT AMOUNT:
BANK CREDIT CARD BY:

MONTHLY PAYMENT AMOUNT:

ANNUAL PERCENTAGE RATE FOR PURCHASES *CASH ADVANCES, BALANCE TRANSFERS. ANNUAL MEMBERSHIP FEE GRACE PERIOD FOR PURCHASES METHOD OF COMPUTING THE BALANCE FOR PURCHASES LATE PAYMENT FEE OVER LIMIT FEE CASH ADVANCE FEE
Variable Rate**
13.92%-Basic
12.48%-Gold
NONE 25 DAYS AVERAGE DAILY BALANCE INCLUDING NEW PURCHASES* NONE NONE NONE
Variable rate information BALANCE TRANSFER APR CHANGE PENALTY APR CHANGE MINIMUM FINANCE CHARGE TRANSACTION FEE FOR PURCHASES TRANSACTION FEE FOR CASH ADVANCES NONE
We reserve the right to change the rate according to Texas law regarding maximum allowed rates. NONE NONE NONE NONE NONE NONE
Because rates and terms are subject to change, you may contact us for the current information by writing us at the address located on the contact page or use our EMAIL address.

*A finance charge will be imposed on Credit Purchases only if you neglect not to pay the entire New Balance shown on your monthly statement for the previous billing cycle within 25 days from the closing date of the statement. If you elect not to pay the entire New Balance shown on your previous monthly statement within that 25-day period, a Finance Charge will be imposed on the unpaid average daily balance of such Credit purchases from the previous statement closing date and on new Credit Purchases from the date of posting to your account during the current billing cycle, and will continue to accrue until the closing date of the billing cycle preceding the date on which the entire new balance is paid in full or until the date of payment if more than 25 days from the closing date. The Finance Charge for a billing cycle is computed by applying the monthly Periodic Rate to the average daily balance of Credit Purchases, which is determined by dividing the sum of the daily balances during the billing cycle by the number of days in the billing cycle. Each daily balance of Credit Purchases is determined by adding to the outstanding unpaid balance of Credit Purchases at the beginning of the billing cycle any new Credit Purchases posted to your account, and subtracting any payments received and credits as posted to your account, but excluding any unpaid Finance Charges. A finance charge will be assessed on cash advances from the date of the cash advance, or the first day of the billing cycle in which the cash advance is posted, whichever is later, and will continue to accrue until the date of payment.
Credit Account Protector (Cap) helps protect your credit rating and your family by making your minimum monthly payments up to $500 if you become involuntarily unemployed, totally disabled, or take an unpaid leave of absence for 30 days or more. It will pay your balance in full, up to $10,000 if you or your spouse die or suffer dismemberment.

Total benefits are limited to the lesser of your outstanding balance as of the date of loss or $10,000. CAP costs no more than $.81 per $100 of your balance each month and there's no charge when there's no balance on your account. Interest (except for CA life and disability benefits), premium accrued and charges made after the date of loss are not covered. This insurance is optional and you may cancel at any time. The effective date of coverage is the next statement billing date after receipt and acceptance of your enrollment. If you enroll, carefully read the certificates which we send you. Enroll now by signing and returning the bottom of your application.

Eligibility: You are eligible for CAP if you are a cardholder, under the age of 71(age 65 in CA; 66 in DE) and your account is in good standing. The person whose signature appears on the enrollment form is designated as the primary cardholder; only one primary cardholder per account. CAP covers only the primary cardholder for disability, unemployment and family leave. You must be insured at date of loss to qualify for benefits. Benefits are determined as of the date of loss. Coverage stops when you reach age 71 (age 65 in CA; 66 in DE; 72 in NM), or when your account becomes 90 days past due. Spousal benefits are not available in NJ, NY, NC, PA &TX. CAP is not available in VA. CO residents must be currently employed to enroll.

Unemployment Benefit: Unemployment must be involuntary and does not cover retirement, resignation, incarceration, periods in which you are paid for work previously done, or self-employed people unless the business is closed for financial reasons. You must be gainfully employed at least 30 hours per week at the time of loss, and you must register at your local unemployment office. Benefits are not available in HI, ME, MA, MN, NY, PA &VT. Strike is not covered in IL. In AZ there is no maximum age limitation for involuntary unemployment insurance.

Family Leave Benefit: The unpaid leave of absence must be due to special circumstance (i.e. birth or adoption of a child, accident or illness affecting an immediate family member, a call to active military duty or residence in a federally declared disaster area). You must be employed a minimum of 30 hours per week. Family leave resulting from a preexisting illness of an immediate family member will not be covered in the first six months. Your coverage must be in force for 90 days before any claims are covered, and each covered claim is limited to six months of benefits. In CA, insurance premiums are reimbursed during family leave claims. Family leave benefits are not available in CT, HI, KS, MA, MD, ME, MN, NH, NM, NY, OR, PA, TX &VT.

Life, Dismemberment and Disability Benefits: For CA and TN, CAP pays the balance on the account as of date of death of the primary account holder or the joint account holder up to $10,000. AL suicide excluded first year. A dismemberment is defined as loss of sight in both eyes or hand or a foot. Dismemberment is not covered in CA, KS, MN, NJ, PA, RI, & WA. Total disability means that due to accidental injury or sickness you are unable to perform the duties of your occupation and you must be attended by a licensed physician other than yourself. Disability benefits for ME & MA residents commence on the 31st day of disability. To be eligible for disability coverage, you must be gainfully employed 30 hours per week at the time your claim begins except in CA, GA, ID, IN, ME, MD, MI, MO, NM, OK, TN, TX & WA. Disability benefits are not available in NY & PA. CA residents are not covered for disabilities resulting from normal pregnancy or intentionally self-inflicted injuries and may receive only limited benefits for other disabilities or suicide.

Monthly Program Costs Per $100 Balance: $.81 in AR, DE, DC, FL, IL, IN, KY, LA, MS, OH, OK, TN, WV;$.80 in MT, RI; $.79 in SD; $.76 in AL, AZ, CA, ID, IA, MI, NV, NC, ND, SC, UT, WY; $.72 in WI; $.71 IN AK, GA, NJ; $.68 in NE; $.66 in MO; $.65 in KS, WA; $.60 in MD; $.59 in NM; $.58 in OR; $.56 in NH; $.55 in CT; $.50 in CO; $.30 in MN; $.253 in TX; $.22 in MA; $.19 in ME, HI, VT; $.1088 in NY; $.07 in PA. The cost will be charged to your account each month. Premium rates can be increased upon written notice. If you cancel coverage within 30 days after receipt of your certificate, all premiums will be refunded.

Insurance Providers: Life, Dismemberment and Disability insurance underwritten by: The United States Life Ins. Co., New York, NY (forms G-19101/19081) in NY; All American Life Ins. Co., Springfield, IL (form GCL275 Series) in NH; American General Assurance Co./USLIFE Credit Life Ins. Co., Schaumburg, IL (form 280 in ME, form 275 in all other states). Involuntary Unemployment and Family Leave insurance underwritten by: American General Indemnity Co. Omaha, NE (form USI & UIC Series); Montgomery Ward Ins. Co., Schaumburg, IL (form 260 & 264 Series); and Colonial Penn Franklin Ins. Co., Valley Forge, PA (form 360 & 364 Series).

If you live in NJ, PA or TX, please read the following: NJ residents may choose life and disability insurance coverage only ($.20 per $100 balance), and TX residents may choose life & disability insurance coverage only ($.196 per $100 balance). Please write to American General Bancassurance Services Inc., CAP Services, 1000 E. Woodfield Road, Suite 300, Schaumburg, IL 60173 and request a special CAP enrollment form for Equifax Card Services. PA residents: your signature on the enrollment form indicates your request for a special CAP application form as you may not enroll through this offer.

This disclosure is accurate as of January 1, 2004 and may be subject to change.

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 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. I/We agree to be bound by the terms and conditions of the bank card agreement, a copy of which will be mailed to the applicant if this application is granted, receipt of such agreement and acceptance of such terms to be conclusively presumed by the applicant's use. If this is a joint application, the undersigned shall be jointly and severally liable for any and all credit extended from time to time.

Please enroll me in the optional CAP insurance program. I have read and understood the insurance and cost disclosures as described herein. CAP costs vary by state but won't exceed .81 per $100 of my monthly balance. The cost will be charged to my account each month. This insurance is voluntary and I may cancel at any time.

Yes, I want CAP Insurance
No, I do not want CAP Insurance at this time.