Prime Advantage Visa & MasterCard Application

*Please Choose One   MasterCard Gold
Visa Gold
MasterCard
Visa Classic		 MasterCard Horses
Visa Liberty
MasterCard Mountains
Visa Beach

Applicant
*Last Name  
*First Name  
*Middle Initial  
*Mother's Maiden Name  
*Street Address  
*City, State, Zip  
*Years at Address  
*Mailing Address  
*City, State, Zip  
    Own or Rent
Name of Landlord or Mortgage Co.  
Monthly Rent or Mortgage Payment  
*Birth Date  
*Social Security Number  
*Home Phone  
Cell Phone  
Previous Street Address  
Previous City, State, Zip  
Years at Address  
*Current Employer
Position
Business Phone
Years at Company
*Gross Monthly Income
Other Income
Source of Other Income
Previous Employer
Position
Business Phone
Years at Company
*Name of Closest Relative Not Living With You
*Home Phone
Address of Closest Relative
City, State, Zip


Co-Applicant or Authorized User

Complete the following questions about the joint applicant or authorized user if you are applying for a joint account or an account that you and another person will use. If you are relying on alimony, child support, or separate maintenance payments or on the income or assets of another person, complete regarding that person.
We intend to apply for joint credit
(please initial) 		Applicant   Co-Applicant
Name
Birth date
Social Security Number
Street Address
City, State, Zip
Years at Address
Current Employer
Business Phone
Years at Company
Gross Monthly Income

(Alimony, child support, or separate maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying the obligation.)
Name of Closest Relative Not Living With You
Home Phone
Address of Closest Relative
City, State, Zip

Balance Transfer

1. Account Number  
Amount to be Paid  
Pay To  
Address  
City, State, Zip  
2. Account Number  
Amount to be Paid  
Pay To  
Address  
City, State, Zip  

Initial balance transfers are free. If you currently have a minimum payment due, please pay it in order to avoid delinquency while your application and/or the balance transfer is being processed. Balance transfers are subject to your available credit limit. In the event that your request(s) exceeds the amount of your credit line, we will fulfill your request(s) up to your available credit limit. We may decline to process one(1) or more requests and/or we may complete one (1) request in a partial amount. If you have a dispute with any creditor and you pay the balance by transferring it, you may lose certain rights.

Agreement

If for some reason you do not meet Gold Card qualifications, this application will be processed for a Classic or Standard Card. The minimum combined income requirement for a Gold Card is $22,500 annually.

Annual Percentage Rate (Includes purchases, cash advances, and balance transfers) 12.40%
Variable Rate Information Your Annual Percentage Rate may vary.*
Grace Period for Repayment of Balances for Purchases 25 Days. No grace period on cash advances.
Annual Fee None
Method of Computing the Balance for Purchases Average Daily Balance (Including new purchases and cash advances)
Additional Fees Late Payment Fee: $19 if balance is $100 or less; $29 for balances between $100.01 and $1000; $39 on balances over $1000
Over Credit Limit Fee: $29.00
Cash Advance Fee: 3% or $5.00 minimum (includes convenience checks)
Returned Check, ACH, or Autopay Fee: $29.00

*The APR is determined by adding a margin of 5.9% to the Prime Rate as published in The Wall Street Journal on the third Thursday of each month. The information about the cost of the card described in this application is accurate as of 9/1/05. This information may change after that date. To find out what may have changed, call us at (800) 854-7642 or write BankCard Center, P.O. Box 674824, Marietta, GA 30006-0005.

Auto Draft Option

Simplify your credit card payment process. Eliminate check writing, postage, and mailing of your payment each month by making your payment electronically from an account you predetermine. Pay monthly minimum, balance in full, or a designated amount - you decide.

Auto Pay Draft Authorization for Prime Advantage Credit Card Account

I hereby authorize the BankCard Center to automatically withdraw (draft) my credit card payment from my (please select one)

Checking Account or Savings Account

I acknowledge that the origination of these ACH transactions to my account must comply with the provisions of U.S. Law.

Financial Institution  
Branch, If Applicable  
City, State, Zip  
Routing Number  
Checking or Savings Account #  

I would like to have (please check one)
  Minimum payment due drafted from my account each month.
  Entire outstanding balance drafted from my account each month.
  Fixed amount of $ drafted from my account monthly.

The minimum payment required is 2.5% of the outstanding balance. This authorization is to remain in full force and effect until the BankCard Center has received written notification from me of its termination in such time and in such manner as to afford the BankCard Center and the financial institution named above a reasonable opportunity to act on it.

*Required

Signatures

To help the government fight the funding of terrorism and money laundering activities, Federal law requires us to obtain, verify, and record information that identifies each person who opens an account. The information requested includes name, street address, date of birth, and Social Security number. We may also ask to see your driver's license or other identifying information. The undersigned individual(s) understands that the use of any card issued in connection with this application shall be subject to the terms of the Prime Advantage Agreement and Disclosure statement which will be sent with the card. The individual applicant and the joint applicant will be liable for all charges incurred jointly and separately according to the Prime Advantage Agreement and Disclosure. I/We authorize The Bankers Bank to investigate any facts, or obtain and exchange any reports regarding the application or resulting account with credit reporting agencies and others including affiliates of The Bankers Bank. Upon request I/we will be informed of each agency's name and address. I/We understand that you will retain this application whether or not it is approved. I/We have read this entire application, agree to its terms, and certify this information is correct.

Signature of Applicant

 Date
Signature of Co-Applicant
 		 Date

Please note that applications submitted will not be processed until we have verified your information and identity by having you visit one of our Cornerstone National Bank offices. A Customer Service Representative will contact you within 2 business days of your request.