FSB VISA Cash Back Card Application

First Security Bank VISA Cash Back Card Application

Consumer

* Required fields. Must be at least 18 years old to apply.

This application is to*

Apply for a new credit card accountRequest a credit limit increaseAdd authorized usersAdd an account co-owner

Application date

Please enter today's date

E-SIGN ELECTRONIC DISCLOSURE AND CONSENT AGREEMENT*

By clicking the checkbox, I certify that I have read and agree to the E-SIGN ELECTRONIC DISCLOSURE AND CONSENT AGREEMENT above

Request to release the CD on a CD Secured card

New Credit Card Application

Credit Limit increase request

Request to add Authorized Users to an existing card account

Request to add a Co-Owner to an existing card account

This application is CD Secured

This application is to RELEASE the CD on a CD Secured card

This application is also a request to RELEASE the CD on a CD Secured card

Upload the CD security agreement (signed)*

Only PDF or image files (jpg, jpeg, png, gif) can be uploaded.

Last 4 digits of the existing card number

Format: 0000.

Applicant name*

First nameMiddle name or initialLast name

Social Security Number/ITIN*

Format: 000-00-0000.

Date of Birth*

Main phone*

Format: (000) 000-0000.

Cell phone

Format: (000) 000-0000.

Number of dependents*

Years at current address*

Monthly mortgage/rent payment $

Residence type*

OwnOtherRent

Current residential address*

Street address

Street Address Line 2

CityState

Zip Code

Previous address (years at current address are less than 3 years)*

Previous address street

Street Address Line 2

Previous address CityPrevious address State

Previous address Zip Code

+ Mail my statement to a different address (Mailing Address)

Mailing address

Mailing address street

Street Address Line 2

Mailing address CityMailing address State

Mailing address Zip Code

Is the Applicant a U.S. citizen?*

YesNo

Is the Applicant a permanent U.S. resident alien?*

YesNo

Current employer name*

Current employer phone*

Format: (000) 000-0000.

You entered First Security Bank (or affiliate) as current employer. Please follow this process for FSB employees:

1. Complete, review and print this online application (leave the "Gross monthly income" field BLANK)

2. Sign the printed copy

3. Return to this online application and click the "Submit application" button

4. Deliver the signed copy to your branch loan officer (assigned to process FSB employee loans)

Applicant comments (FSB employee) - optional

Job position or occupation*

Years with employer*

Less than 1 year1 or more years

Previous employer name*

Previous employer phone*

Format: (000) 000-0000.

Previous job position or occupation*

Gross MONTHLY income $ (a)*

(a) Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Other MONTHLY income $ (a)

If none, please leave it blank (do not enter zeros)

Note: Spousal income will not be considered unless spouse is a co-applicant.

Gross monthly income source*

Other monthly income source

If "Other/none" was selected as gross monthly income source, enter the income type here

Note about the "Other monthly income source" field: if RETIRED, please enter the specific source, like SSI (Social Security Income), investment income, pension, disability, retirement income, etc.

Applicant email address

By providing your email address, we may use it to send you information and notifications about your application and credit card account (if approved)

Requested credit limit $ (b)

(b) Credit Limit: First Security Bank determines, in its sole discretion, the credit limit on your credit card account by evaluating several factors, including (but not limited to) your credit history, credit score and income. First Security Bank reserves the right to approve the credit limit amount you requested or to approve a lower credit limit amount.

BALANCE TRANSFER

Complete a Balance Transfer from my other financial institution's credit card/loan as described in the attached account statement (c)

Upload the other bank's card/loan statement*

Only PDF or image files (jpg, jpeg, png, gif) can be uploaded.

(c) First Security Bank may transfer a lower amount depending on your available credit limit. You cannot transfer balances between two First Security Bank accounts. There is no grace period on Balance Transfers (you will pay interest from the moment it is completed). Balance Transfers do not earn Cash Back. Continue to make your other financial institution credit card or loan payments until you confirm that the transferred payment has been received by your other creditor. The minimum payment on your First Security Bank credit card will increase once the transfer is complete.

Add a Co-applicant

The co-applicant is equally responsible as the applicant for all charges made or allowed on the credit card account.

* Required fields. The co-applicant must be at least 18 years old to apply.

Co-applicant name*

First nameMiddle name or initialLast name

Co-applicant Social Security Number/ITIN*

Format: 000-00-0000.

Co-applicant Date of Birth*

Co-applicant main phone*

Format: (000) 000-0000.

Co-applicant cell phone

Format: (000) 000-0000.

Co-applicant number of dependents*

Co-applicant years at current address*

Co-applicant monthly mortgage/rent payment $

Co-applicant residence type*

OwnOtherRent

Is the Co-applicant a U.S. citizen?*

YesNo

Is the Co-applicant a permanent U.S. resident alien?*

YesNo

Co-applicant current employer name*

Co-applicant current employer phone*

Format: (000) 000-0000.

You entered First Security Bank (or affiliate) as co-applicant current employer. Please follow this process for FSB employees:

1. Complete, review and print this online application (leave the "Gross monthly income" field BLANK)

2. Sign the printed copy

3. Return to this online application and click the "Submit application" button

4. Deliver the signed copy to your branch loan officer (assigned to process FSB employee loans)

Co-applicant comments (FSB employee) - optional

Co-applicant job position or occupation*

Co-applicant years with employer*

Less than 1 year1 or more years

Co-applicant previous employer name*

Co-applicant previous employer phone*

Format: (000) 000-0000.

Co-applicant previous job position/occupation*

Co-applicant gross MONTHLY income $ (d)*

(d) Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Co-applicant other MONTHLY income $ (d)

If none, please leave it blank (do not enter zeros)

Co-applicant gross monthly income source*

Co-applicant other monthly income source

If "Other/none" was selected as gross monthly income source, enter the income type here

Note about the "Co-applicant other monthly income source" field: if RETIRED, please enter the specific source, like SSI (Social Security Income), investment income, pension, disability, retirement income, etc.

Co-applicant email address

Add authorized user #1

AUTHORIZED USER(S)

The applicant and the co-applicant (if this is a joint application), are responsible for all charges made or allowed by the authorized user(s). Before adding an authorized user, let him/her know that we may report their card use and performance to the credit reporting agencies in the authorized user's name.

Authorized user #1 name*

First nameMiddle name or initialLast name

Authorized user #1 Date of Birth*

Add authorized user #2

Please complete first the Authorized User #1 fields.

Authorized user #2 name*

First nameMiddle name or initialLast name

Authorized user #2 Date of Birth*

Last 4 digits of the existing card number*

Format: 0000.

Requested new credit limit $ (a)*

(a) Credit Limit: First Security Bank determines, in its sole discretion, the credit limit on your credit card account by evaluating several factors, including (but not limited to) your credit history, credit score and income. First Security Bank reserves the right to approve the credit limit amount you requested or to approve a lower credit limit amount.

Account owner name*

First nameMiddle name or initialLast name

Account owner Social Security Number/ITIN*

Format: 000-00-0000.

Account owner Date of Birth*

Account owner main phone*

Format: (000) 000-0000.

Account owner cell phone

Format: (000) 000-0000.

Acct. owner monthly mortgage/rent payment $

Account owner residence type*

OwnOtherRent

Account owner residential address*

Acct owner street address

Street Address Line 2

Acct owner CityAcct owner State

Acct owner Zip Code

Is the account owner a U.S. citizen?*

YesNo

Is the account owner a permanent U.S. resident alien?*

YesNo

Account owner current employer name*

Account owner current employer phone*

Format: (000) 000-0000.

You entered First Security Bank (or affiliate) as account owner current employer. Please follow this process for FSB employees:

1. Complete, review and print this online application (leave the "Gross monthly income" field BLANK)

2. Sign the printed copy

3. Return to this online application and click the "Submit application" button

4. Deliver the signed copy to your branch loan officer (assigned to process FSB employee loans)

Account owner comments (FSB employee) - optional

Account owner job position or occupation*

Account owner years with employer*

Less than 1 year1 or more years

Account owner previous employer name*

Account owner previous employer phone*

Format: (000) 000-0000.

Acct owner previous job position or occupation*

Account owner gross MONTHLY income $ (b)*

(b) Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Account owner other MONTHLY income $ (b)

If none, please leave it blank (do not enter zeros)

Note: Spousal income will not be considered unless spouse is a co-owner on the account.

Account owner gross monthly income source*

Account owner other monthly income source

If "Other/none" was selected as gross monthly income source, enter the income type here

Note about the "Account owner other monthly income source" field: if RETIRED, please enter the specific source, like SSI (Social Security Income), investment income, pension, disability, retirement income, etc.

Account owner email address

By providing your email address, we may use it to send you information and notifications about your application and credit card account (if approved)

ACCOUNT CO-OWNER

If the existing credit card account has a co-owner, the "The account has a co-owner" checkbox below should be selected and the co-owner section completed, otherwise this application may be declined.

The account has a co-owner

The co-owner is equally responsible as the account owner for all charges made or allowed on the credit card account.

* Required fields. The co-owner must be at least 18 years old to apply.

Co-owner name

First nameMiddle name or initialLast name

Co-owner Social Security Number/ITIN

Format: 000-00-0000.

Co-owner Date of Birth*

Co-owner main phone*

Format: (000) 000-0000.

Co-owner cell phone

Format: (000) 000-0000.

Co-owner number of dependents*

Co-owner years at current address*

Co-owner residential address*

Co-owner street address

Street Address Line 2

Co-owner CityCo-owner State

Co-owner Zip Code

Co-owner monthly mortgage/rent payment $

Co-owner residence type*

OwnOtherRent

Is the co-owner a U.S. citizen?*

YesNo

Is the co-owner a permanent U.S. resident alien?*

YesNo

Co-owner current employer name*

Co-owner current employer phone*

Format: (000) 000-0000.

You entered First Security Bank (or affiliate) as co-owner current employer. Please follow this process for FSB employees:

1. Complete, review and print this online application (leave the "Gross monthly income" field BLANK)

2. Sign the printed copy

3. Return to this online application and click the "Submit application" button

4. Deliver the signed copy to your branch loan officer (assigned to process FSB employee loans)

Co-owner comments (FSB employee) - optional

Co-owner job position or occupation*

Co-owner years with employer*

Less than 1 year1 or more years

Co-owner previous employer name*

Co-owner previous employer phone*

Format: (000) 000-0000.

Co-owner previous job position or occupation*

Co-owner gross MONTHLY income $ (bb)*

(bb) Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Co-owner other MONTHLY income $ (bb)

If none, please leave it blank (do not enter zeros)

Co-owner gross monthly income source*

Co-owner other monthly income source*

If "Other/none" was selected as gross monthly income source, enter the income type here

Note about the "Co-owner other monthly income source" field: if RETIRED, please enter the specific source, like SSI (Social Security Income), investment income, pension, disability, retirement income, etc.

Co-owner email address

Authorized User(s)

The account owner and co-owner (if this is a joint account), are responsible for all charges made or allowed by the authorized user(s). Before adding an authorized user, let him/her know that we may report their card use and performance to the credit reporting agencies in the authorized user's name.

Authorized user 1 - Name*

First nameMiddle name or initialLast name

Authorized user 1 - Date of Birth*

Authorized user 2 - Name

First nameMiddle name or initialLast name

Authorized user 2 - Date of Birth

Authorized user 3 - Name

First nameMiddle name or initialLast name

Authorized user 3 - Date of Birth

FOR INTERNAL USE ONLY - required for the FSB employee filling the application - PLEASE CHECK BOX

As an employee of First Security Bank I certify that (a) the applicant and co-applicant (if a joint application); or the account owner and co-owner (if a joint account), are physically present here at the FSB Banking Center and provided me the information to complete this application; (b) I have properly identified them following the FSB CIP procedures; (c) I am completing and submitting this application on their behalf; or sending this application by email to the applicant to be submitted directly by the applicant; and (d) I read and/or provided them the required disclosures and terms and conditions.

FSB employee information - REQUIRED for the FSB employee filling the application - Do not leave blank.

FSB Employee NameFSB Banking Center

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING/SUBMITTING:

This application is submitted to obtain credit and I/We certify that all information 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 “Card Membership Rules”, a copy of which will be mailed to the applicant. If this application is granted, receipt of such agreement and acceptance of such terms is 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. You authorize us to contact you using any of your telephone numbers – regardless whether the number we use is assigned to a cellular telephone service, paging service, specialized mobile radio service, or other radio common carrier service for which you may be charged for the call. You further authorize us to contact you through the use of voice, through the use of prerecorded/artificial voice messages or an automatic dialing device, text messages (your mobile provider's message and data rates may apply), and email (including the delivery of account documents).

By signing/submitting this application, I/We agree to this card account Terms & Conditions

SIGNATURE(S) - Not required if the applicant is directly submitting online from his/her own device

______________________________ ______________________________
Account owner Co-owner (if this is a joint account)

SIGNATURE(S) - Not required if the applicant is directly submitting online from his/her own device

______________________________ ______________________________
Account applicant Co-applicant (if this is a joint application)

FSB BANKER: click "Review application" below and print the application summary. Have it signed by the applicant (and co-applicant if this is a joint application) and send it by email to the FSB Tech Center. Return to the online application and click "Submit application".

FSB BANKER: click "Review application" below and print the application summary. Have it signed by the account owner (and co-owner if this is joint account) and send it by email to the FSB Tech Center. Return to the online application and click "Submit application".

APPLICANT (and co-applicant if this is a joint application): click "Review application" below and verify the summary information is correct. Click "Submit application".

ACCOUNT OWNER (and co-owner if this is a joint account): click "Review application" below and verify the summary information is correct. Click "Submit application".

ACCOUNT CO-APPLICANT

If this application has a co-applicant: By clicking the "Review-print-submit application" button below, I/We certify that this application is being submitted by both the applicant and the co-applicant.

ACCOUNT CO-OWNER

If the existing credit card account has a co-owner: By clicking the "Review-print-submit application" button below, I/We certify that this application is being submitted by both the account owner and the account co-owner.

ACCOUNT CO-OWNER

By clicking the "Review-print-submit application" button below, I/We certify that this application is being submitted by both the account owner and the account co-owner.

Please verify you are a human*

Once you click the "Review Application" button, the application summary will display including the "Print" and "Submit Application" buttons.

FSB employee disclosure box was checked?

Applicant or account Owner

Application type

App type email

Is applicant Retired?

Is Co-applicant Retired?

Is account owner Retired? - cr limit increase

Is Co-owner Retired? - cr limit increase

Is Co-owner Retired? - add Co-owner

RELEASE the CD

Credit limit increase and RELEASE the CD

Application IP address