Credit Card Application
Privacy Policy:
Our privacy policy protects the privacy of your personally-identifying information that you provide us online.

Account Holders must reside in    

Important Information about Procedures for Opening a New Account
Identification Procedures Requirements: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

Instructions:
1. Print this loan application and gather the information you'll need.
2. Complete application on-line and click "Submit Application" or fax it to 404-575-8312.
3. To safeguard your privacy, QUIT your browser and restart it again after using this form.

This loan application is for personal loans only and is NOT intended for commercial use. A valid social security number is required to apply. Please review and gather the information you will need before completing this form. Upon receipt of the application, we will send you the proper disclosures.

Credit Card Request
Credit Limit Requested:
    
Type of Application:
   
Mother's Maiden Name:
 
I'm applying for a:
Visa Classic Visa Gold
Visa Secure CTB Visa Business
ATL Visa Card

Applicant
First Name
    
Middle Initial
 
Last Name
    
Date of Birth
    
Social Security No.
    
No. of Dependents
    
Driver's License Number
    
Driver's License State
   
Your E-mail Address
    
Home Phone
    
Best Time To Call
 
Work Phone
    
Application Closest Relative
not living with you
    
 
Relationship
      

Contact Phone Number
    
Are there any unsatisfied Judgments against you?    
Have you been declared bankrupt in the last 7 years?    

Residence
Your Primary Residence:    
Present Street Address
    
City
    
State
   
Zip
    
Years At Present Address
    
Your Monthly Rent or Mortgage Payment
    
Years At Previous Address
 
Your Previous Address
 

Home Information
Collateral Property Address (If different from above)
 
Date Purchased
 
Current Mortgage Holder
 
Mortgage Holder Phone
 
Purchase Price
 
Market Value
 
Mortgage Balance
 

Employment
Employment Status:    
Your Present Employer
 
Phone
 
Street Address
 
City
 
State
Zip
 
Gross Monthly Salary
 
Your Position
 
Years There
 
You do not have to list alimony, child support or separate maintenance income unless you want us to consider it for the purposes of granting and repayment of this credit request.
Other Monthly Income
 
Source of Other Income
 
Previous Employer
(if less than 3 years at current employer)
 
Years at Previous Employer
 
Street Address
 
City
 
State
Zip
 

Additional Information
Your Checking Account Number
 
Institution Name
 
Your Savings Account Number
 
Institution Name
 
Name of Creditor Approx. Balance Monthly Payment Collateral, if any
       
       
       
       
Total Amount of "Other" Monthly Payments not listed above:
 
Assets
 
Value
 
Title Held Name
 

Is there a Co-Applicant?    

If Yes, Please provide the the requested Co-Applicant information below:


Co-Applicant
First Name
 
Middle Initial
 
Last Name
 
Date of Birth
 
Social Security No.
 
No. of Dependents
 
Driver's License Number
 
Driver's License State
Your E-mail Address
 
Home Phone
 
Best Time To Call
 
Work Phone
 
Are there any unsatisfied Judgments against you?
Have you been declared bankrupt in the last 7 years?

Co-Applicant Residence
Your Primary Residence:
Present Street Address
 
City
 
State
 
Zip
 
Years At Present Address
 
Your Monthly Rent or Mortgage Payment
 
Years At Previous Address
 
Your Previous Address
 

Co-Applicant Home Information
Collateral Property Address (If different from above)
 
Date Purchased
 
Current Mortgage Holder
 
Mortgage Holder Phone
 
Purchase Price
 
Market Value
 
Mortgage Balance
 

Co-Applicant Employment
Employment Status:
Your Present Employer
 
Phone
 
Street Address
 
City
 
State
Zip
 
Gross Monthly Salary
 
Your Position
 
Years There
 
You do not have to list alimony, child support or separate maintenance income unless you want us to consider it for the purposes of granting and repayment of this credit request.
Other Monthly Income
 
Source of Other Income
 
Previous Employer
(if less than 3 years at current employer)
 
Years at Previous Employer
 
Street Address
 
City
 
State
Zip
 

Co-Applicant Additional Information
Your Checking Account Number
 
Institution Name
 
Your Savings Account Number
 
Institution Name
 
Name of Creditor Approx. Balance Monthly Payment Collateral, if any
       
       
       
       
Total Amount of "Other" Monthly Payments not listed above:
 
Assets
 
Value
 
Title Held Name
 

Applicant(s) Statement
I/We have completed this request for credit in consideration of Citizens Trust Bank lending to me and/or others upon my guarantee. I/We certify that all information contained herein is accurate and complete to the best of my knowledge.

I/We authorize Citizens Trust Bank to retain property of this application, to rely on the foregoing, to check and verify my credit, employment and salary history, to secure follow up credit reports concerning my credit worthiness and to exchange information about my account with proper persons, creditors and credit bureaus.

I authorize my employer (present and future), bank and other references listed above to release and/or verify information to Citizens Trust Bank at any time. I acknowledge that this application is subject to approval of credit and acceptance by Citizens Trust Bank . Should my request for credit and subsequent loan be approved, I agree to give Citizens Trust Bank written notice immediately upon change of my name, address, employment or any other pertinent information contained herein.
I/We AGREE with the above statement

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