Simonson

Printable Application

Personal Credit Application

1. Tell us about yourself

First Name

Middle Name

Last Name

Home Phone

Date of Birth

Email Address

Current Address

Apt. #

City

State

Zip

Time at Current Address:

Years

Months

2. Tell us about your work

Employer

Address

City

State

Zip

Phone Number

Annual Salary

Time at Employer Years: Months:

Occupation

Other Annual Income *$

Source of Other Income $

*You don't have to tell us about alimony, child support or separate maintenances income unless you want us to consider them in approving your application.

3. Other information you may want us to consider

Complete only if:
You wish to establish a joint or co-applicant account
If you are relying on spouse's income, alimony, child support or separate maintance payments to establish your creditworthiness or;
If your spouse will use the account.

CO-APPLICANT

First Name

Middle Name

Last Name

Home Phone

Date of Birth

Address

City

State

Zip

Other Information We Need
Our Charge Cards require a PIN number for proper security purposes. Please list everyone authorized to charge on your account and a selected 4-digit PIN number. Example: John Doe #1000, Jane Doe #1001, Susie Doe # 1002. Everyone must have a different 4-digit PIN number. These numbers are necessary in order to accurately process your statements with a detailed listing of all account transactions according to each user. If you have any questions concerning this process, please call 701-772-3971 and ask for Brent.

Authorized User & PIN

By pressing Submit I agree that you may verify the above, check my credit history, and secure follow-up credit reports on me, I (we) also agree to pay all finance charges.

By submitting this application I agree to the terms and conditions set forth in the credit card application.

Security Image:

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Enter Security Code: