The Citizens Bank

PERSONAL CREDIT CARD APPLICATION

To apply for The Citizens Bank Personal Credit Card, you must do so in person at one of our local branch locations. We have made the application available here if you want to fill it out ahead of time. When finished, simply select PRINT at the bottom of the form and bring the signed and printed form into your local branch for further assistance.

We intend to apply for joint credit:

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Mailing Address (if different)

Previous Address

Enter your previous address if you have lived at your current address less than 2 years.

Employment Information

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Previous Employer

If you have been employed at your current job less than two years, provide information on your previous employer.

Additional Income

Relative

Credit Info

Bank Credit Card Account

Co-Applicant Information

Co-Applicant Previous Address

Enter the co-applicant's previous address if he/she has lived at their current address less than 2 years.

Co-Applicant Employment Information

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SIGNATURES

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING: This statement is submitted to obtain credit and I / We certify that all information herein 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 application is subject to the credit policies of this institution. I / We agree to be bound by the terms and conditions of the bank card agreement, a copy of which will be mailed to the applicant if this application is granted, receipt of such agreement and acceptance of such terms to be conclusively presumed by the applicant’s use. If you intend to apply for joint credit, the undersigned shall be jointly and severally liable for any and all credit extended from time to time. We may report information about your account to the credit bureaus. Late payments, missed payments, or other defaults on your account may be reflected in your credit report.

Balance Transfer

Upon approval, I wish to transfer my present balance on the card account(s) listed below to my new The Citizens Bank credit card account. The balance transfer will be subject to finance charges to the day of posting to your new account.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, Federal laws require all financial institutions to obtain, verify and record information that identifies each person who opens an Account. What this means to 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.

Once you have filled out this form, the applicant and co-applicant should sign and date the printed form.