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?
- 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.
- I am applying for joint credit and have authorization to apply on behalf of any
If you need assistance filling out this application
please call our Customer Service Center at (855) 383-4301 or (316) 383-4301.