Bank of Springfield Credit Card Application
ABOUT YOURSELF
Applicant’s Last Name
PLEASE PRINT ALL INFORMATION CLEARLY. USE BLACK INK.
First
Present Street Address
Previous Home Address
How Long at Address
Yrs.
City
Nearest Relative Not at Residence
Name
Address
City
Telephone No.
A/C (
)
Initial
Date of Birth
Social Security Number
Apt.#
City
Zip Code
Own
Rent
Other
State
Monthly Payment
Mos.
Zip Code How Long at Previous Address
Yrs.
Mos.
State
Zip Code Telephone No.
A/C (
)
ABOUT YOUR WORK
Employer
Employer’s Address
City
State
Zip Code
Occupation
Annual Income
No. Years Employed
Previous Employer
Previous Employer’s Address
City
Telephone No.
A/C (
)
State
Zip Code
OTHER INFORMATION Annual amount and source of other income: include alimony,
child support or separate maintenance only if you wish to have it relied upon for this application. $
Have you ever had any judgements against you?
No
Yes
Have you ever filed bankruptcy?
ABOUT CO-APPLICANT
Applicant’s Last Name
First
Initial
Occupation
Employer
Yes (Please give details on separate sheet.)
No
COMPLETE THIS SECTION ONLY IF ANOTHER PERSON WILL USE THE
CREDIT CARD AND BE CONTRACTUALLY LIABLE.
Date of Birth
Social Security Number
No. of Years Employed
Annual Income
Telephone No.
A/C (
)
Employer’s Address
State
City
Zip Code
Relationship to Applicant
BANK, DEPARTMENT STORE AND FINANCIAL INSTITUTIONS
(OPEN OR CLOSED) (ATTACH SHEET IF NEEDED)
ABOUT YOUR CREDIT REFERENCES
Name of Credit References
Address
Checking Account #
Institution
Savings Account #
Institution
Account Number
“Residents of Illinois may contact the Commissioner of Banks and Trust Companies for comparative information on interest rate, charges, fees and grace periods.”
State of Illinois - CIP P.O. Box 10181 Springfield, IL 62791 (800)634-5452
I (WE) MAKE APPLICATION IN ILLINOIS TO BANK OF SPRINGFIELD FOR A VISA
CHARGE CARD(S). IF THIS APPLICATION IS ACCEPTED AND CHARGE CARD(S)
ARE ISSUED. THE UNDERSIGNED APPLICANT(S) BY SIGNING. USING OR
PERMITTING ANOTHER TO USE THE CHARGE CARD(S) AGREE(S) THAT THE
APPLICANT(S) WILL BE BOUND BY THE TERMS AND CONDITIONS OF THE
CARDHOLDER AGREEMENT ACCOMPANYING THE CHARGE CARD(S) AND ALL
AMENDMENTS. I (WE) GIVE THE ABOVE INFORMATION FOR THE PURPOSE OF
OBTAINING CREDIT AND AUTHORIZE SAID BANK TO OBTAIN INFORMATION
CONCERNING ANY STATEMENTS MADE HEREIN.
Annual
Percentage
(APR)
10.99%*
Other Fees
and
Charges
$25.00 over limit fee
$25.00 late fee
No cash advance fee
Variable
Rate Index
and Spread
NONE
Signature of Individual Applicant
Date
Signature of Co-Applicant
Date
Annual
Membership
Fee
NONE
Method of
Computing Balance
for Purchases
Average Daily
Balance Method
Grace
Period
25 Days on Purchases.**
No Grace Period on
Cash Advances.
Minimum
Finance
Charge
NONE
Transaction
Fee for
Purchases
NONE
The date that this information was printed was January 4, 2005 and was accurate as of January 4, 2005. Please contact Bank of Springfield to
obtain the most current information. The address is 2600 Stevenson Drive, Springfield, IL 62703.
*Rate is subject to credit approval.
**No interest will be charged on purchases made during a billing cycle if the balance at the time beginning and at the end of that cycle is paid in
full within 25 days.
“Residents of Illinois may contact the Office of Banks and Real Estate for comparative information on interest rates, charges, fees and grace
periods.” The address is 500 E. Monroe, Springfield, IL 62701. Phone number is (217) 782-3000.
PLACE
STAMP
HERE
VISA
MASTERCARD...
The most widely recognized credit
cards in the world.
Bank of Springfield
P.O. Box 19301
Springfield, IL 62794-9960
VISA and MASTERCARD are...
6 Simple to obtain - Whether you want a VISA card or
MasterCard or both, just complete the application on
the reverse side and drop it in the mail.
6 Inexpensive to carry - No annual fees for VISA or
MasterCard
6 Convenient to use - With VISA or MasterCard you
may choose to pay your account in full each month, or
you may choose to extend your payments over a period
of time. You receive an itemized statement every month
you are billed.
6 Instantly recognized all over the world - VISA and
MasterCard are widely accepted and widely used
throughout the world. Millions of people use their
cards at more than 3 million stores in 130 countries. If
you have a VISA or MasterCard card, your credit is
good across the country and around the world.
6 Practical for travel - Carry your VISA card or
MasterCard with you on business trips and on family
vacations in the U.S. And abroad. They are readily
accepted by travel agencies, airlines, hotels, car
rentals, restaurants, gasoline service stations and many
more.
6 Cash - In your hometown or in a strange city, you can
obtain cash advances by presenting your credit card at
any VISA or MasterCard bank. Cash may be obtained
up to the unused credit limit on your VISA or
MasterCard account.
6 Valuable for emergencies - Use VISA or
MasterCard to obtain emergency repairs and services
for your home or car. VISA and MasterCard are also
accepted at some hospitals and clinics by many doctors
and dentists.
6 24 Hour Account Information-For account
information go to www.bankofspringfield.com, and
click on the link to MYCCINFO. Or call toll free 1-800423-7503
01/05