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.
Credit E-Sign
Credit Card Application Requirements

Before proceeding you must confirm that you have read and agree to the terms of the Electronic Signature Act Disclosure available at the link below. If you cannot view the disclosure below, click on the Adobe Reader icon to download the latest version.


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E-SIGN Act Disclosure

Before filling out the Credit Card Application, please review the following Credit Card Terms and Conditions.

Credit Request
Product 001
Primary Applicant Information
Personal Information
(xxx-xx-xxxx)
No P.O. Boxes
(xxx)xxx-xxxx
(mm/dd/yyyy)
(xxx)xxx-xxxx
Employment Information
(month)                  (year)
Alimony, child support or separate maintenance need not be revealed unless you wish to have it considered as a basis for repaying this obligation.
Applicant Disclosures
Co-Applicant is a borrower that is in a spousal relationship to the Primary Applicant
Co-Applicant Information
Personal Information
(xxx-xx-xxxx)
No P.O. Boxes
(xxx)xxx-xxxx
(mm/dd/yyyy)
Employment Information
(month)                  (year)
Alimony, child support or separate maintenance need not be revealed unless you wish to have it considered as a basis for repaying this obligation.
Applicant Disclosures
Secondary Applicant Information
Personal Information
(xxx-xx-xxxx)
No P.O. Boxes
(xxx)xxx-xxxx
(mm/dd/yyyy)
(xxx)xxx-xxxx
Employment Information
(month)                  (year)
Alimony, child support or separate maintenance need not be revealed unless you wish to have it considered as a basis for repaying this obligation.
Applicant Disclosures
Co-secondary applicant is a co-signer that is in a spousal relationship to the secondary applicant
Secondary Co-Applicant Information
Personal Information
(xxx-xx-xxxx)
No P.O. Boxes
(xxx)xxx-xxxx
(mm/dd/yyyy)
Employment Information
(month)                  (year)
Alimony, child support or separate maintenance need not be revealed unless you wish to have it considered as a basis for repaying this obligation.
Applicant Disclosures
Voluntary Government Monitoring Information
COMPLETE THIS SECTION ONLY IF THE PURPOSE OF THE REQUESTED LOAN IS FOR THE PURCHASE, REFINANCE
OR HOME IMPROVEMENT OF A DWELLING AND SECURED BY A DWELLING.
(Not Applicable to Home Equity Lines)
The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the Lender’s compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. You may select one or more designations for “Race.” The law provides that a Lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under Federal regulations the lender is required to note ethnicity, race and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below. (Lender must review the material to assure that the disclosures satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)
Applicant
Additional Information