Personal Credit Card

Primary Applicant

All Applicant, Additional Information, and Agreements fields are required, except those indicated with (Optional)

Personal Information

Amount of Credit Requested

Title

First Name

Middle Name

Last Name

Suffix (Optional)

Street Address

Apartment, Suite, etc (Optional)

City

State

Zip

County

Country

Date of Birth

Social Security Number

Mother's Maiden Name

ID Type

State Issued

ID Number

Issue Date

Expiration Date

Annual Income

Phone

Ext (Optional)

Email

Housing Type

Monthly Housing Payment

Employment

Occupation

Employment Status

Employer

Title

Pre-Tax Monthly Income

Time with Current Employer

Employer Street Address

Employer Apartment, Suite, etc (Optional)

Employer City

Employer State

Employer Zip

County

Country

Non-Employment Income (Optional)

Financial Assets

Co-Applicant

Personal Information

Relation to Applicant

Title

Co-Applicant First Name

Co-Applicant Middle Name

Co-Applicant Last Name

Co-Applicant Street address

Co-Applicant Apartment, Suite, etc

Co-Applicant City

Co-Applicant State

Co-Applicant Zip

Co-Applicant County

Co-Applicant Country

Co-Applicant Date of Birth

Co-Applicant Social Security Number

Co-Applicant ID Type

Co-Applicant State Issued

Co-Applicant ID Number

Co-Applicant ID Issue Date

Co-Applicant ID Expiration Date

Co-Applicant Primary Phone Number

Ext

Co-Applicant Email Address

Co-Applicant Housing Type (if different than Primary)

Co-Applicant Monthly Housing Payment

Co-Applicant Employment

Co-Applicant Occupation

Co-Applicant Employment Status

Co-Applicant Employer

Co-Applicant Title

Co-Applicant Pre-Tax Monthly Income

Co-Applicant Employer Street Address

Co-Applicant Employer Apartment, Suite, etc

Co-Applicant Employer City

Co-Applicant Employer State

Co-Applicant Employer Zip

Co-Applicant Employer County

Co-Applicant Employer Country

Co-Applicant Non-Employment Income

Co-Applicant Financial Assets

Co-Applicant Joint Credit

Yes

No

Additional Information

Authorized Users

Yes

No

Balance Transfer

Yes

No

Agreements

Electronic Signature and Communication Disclosure

This Electronic Signature and Communication Disclosure ("Disclosure") applies to the accounts that you have requested. The words "we," "us," and "our" means Equitable Bank and the words "you" and "your" means you, the individual(s) who have applied for this account. As used in this Disclosure, "Communication" means any authorization, agreement, disclosure, notice of our decision on your application, or other information related to this account including information regarding rates, fees, and other costs related to the financial product for which you are applying.

Electronic Signature Agreement

I am signing this Agreement electronically. I agree this electronic signature (hereafter referred to as "E-Signature") is the legal equivalent of my physical signature on this Agreement. Use of a keypad, mouse or other device to select an item, button, icon, or another similar act/action constitutes my signature acceptance and agreement as if actually signed by me in writing. No certification authority or other third party verification is necessary to validate my E-Signature, and the lack of such certification or third party verification will not in any way affect the enforceability of my E-Signature or any resulting contract. I consent to be legally bound by this Agreement's terms and conditions. I am authorized to enter into this Agreement for all persons who own or are authorized to access any of the accounts and such persons will be bound by the terms of this Agreement.

The Scope of Communications to Be Provided in Electronic Form

When you agree to these terms with respect to the product, you agree that we may provide you with any communications relating to this account in electronic format, and that we may discontinue sending paper communications to you, unless and until you withdraw your consent as described below. Your consent to receive electronic communications and transactions includes, but is not limited to:

•Initial disclosures or agreements for your account

•Notices or disclosures about a change in the terms of this account

•Privacy Notices

Method of Providing Communications to You in Electronic Form

All communications that we provide to you in electronic form will be provided via e-mail at the e-mail address you specify at the time of this account application.

How to Withdraw Consent

You may withdraw your consent to receive communications in electronic form by contacting us at 1-800-641-5046. We may treat your provision of an invalid e-mail address or the subsequent malfunction of a previously valid address as a withdrawal of your consent to receive electronic communications. We will not impose any fee to process the withdrawal of your consent to receive electronic communications. Any withdrawal of your consent to receive electronic communications will be effective only after we have a reasonable period of time to process your withdrawal.

How to Update Your Records

It is your responsibility to provide us with true, accurate and complete e-mail address, contact, and other information related to this account(s), and to maintain and update promptly any changes in this information. You can update such information (such as your e-mail address) by contacting your local branch or calling 1-800-641-5046.

Hardware and Software Requirements

In order to receive disclosures electronically the following hardware and software must be met: a computer or other device which supports an Internet web browser which is capable of supporting HTML and 128-bit SSL encryption; connection to the Internet; and a current version of a program that accurately reads and displays Portable Document Format or "PDF" files, such as Adobe® Acrobat Reader® version 8.0 and above.

Requesting Paper Copies

You can obtain a paper copy of an electronic communication by printing it yourself or by requesting that we mail you a paper copy. To request a paper copy, contact us by telephone at 1-800-641-5046. We may charge you a reasonable service charge for the delivery of paper copies of any communication provided to you electronically pursuant to your authorization. We reserve the right, but assume no obligation, to provide a paper (instead of electronic) copy of any communication that you have authorized us to provide electronically.

Communications in Writing

All communications in either electronic or paper format from us to you will be considered "in writing." You should print or download for your records a copy of this disclosure, and any other communication that is important to you.

Federal Law

You acknowledge and agree that your consent to electronic communications is being provided in connection with a transaction affecting interstate commerce that is subject to the federal Electronic Signatures in Global and National Commerce Act, and that you and we both intend that the Act apply to the fullest extent possible to validate our ability to conduct business with you by electronic means.

Termination/Changes

We reserve the right, in our sole discretion, to discontinue the provision of your electronic communications, or to terminate or change the terms and conditions on which we provide electronic communications. We will provide you with notice of any such termination or change as required by law.

Consent

By clicking the “Submit” button below this disclosure on the screen, you consent to receiving disclosures and documents electronically and to the terms and conditions described in this document.

CREDIT AUTHORIZATION

I certify that I am at least 18 years of age, and that I have read and agree to all the terms, authorization and disclosures contained within the credit card application process and that everything I have stated in this application is true and correct. I authorize Equitable Bank to check my credit record and verify my credit, employment, and income references. I understand that the use of any card issued in conjunction with this offer will constitute my acceptance of and will be subject to the terms and conditions of the Card Agreement. I understand that the terms of my account are subject to change as stated in any disclosures provided in relation to this credit card account.

Applicant Signature

Applicant Signature Date

I acknowledge that I read and agree to the Agreements.

Loan Application

Primary Applicant

Personal Information

Employment

Co-Applicant

Personal Information

Co-Applicant Employment

Additional Information

Agreements