Consumer Credit Application

** INCOMPLETE APPLICATION **

This application has not been submitted.
Required fields are denoted as follows: Field Title
Important Information About Procedures for Opening a New Account. 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 you 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.
Application Taken Date:
An individual on this application is an employee of Emprise Bank?
Individual Credit - I am applying for individual credit in my own name and I am relying on my own income and/or assets and not the income and/or assets of another person.
Joint Credit - I am applying for joint credit and have authorization to apply on behalf of any other applicant(s).
If you need assistance filling out this application please call our Customer Service Center at (855) 383-4301 or (316) 383-4301.