Card Requested
Visa	Mastercard

Credit Line Requested
$500	$3500
$1500	$5000
Other

Applicant
	I intend to apply for separate credit: Complete Applicant section and sign application. Complete Co-Applicant/Spouse section with information about your spouse only if you are married and are a Wisconsin resident.
	I intend to apply for joint credit with spouse: Complete Applicant section and Co-Applicant section and both sign.
	I intend to apply for joint credit with someone who is not my spouse: Each of you must complete separate applications as if applying for separate credit and submit them together, including completing Spouse/Co-Applicant section if you are married and a Wisconsin resident.
Blue=Required

Briefly Tell Us About Yourself
First Name	Initial	Last	Date Of Birth	SS Number
Address	City	State	Zip Code	Home Phone
Own Rent Other		How Long Have You Lived At This Residence?		Monthly Payment
For Wisconsin Residents Only Married Unmarried Legally separated
Employer		Years On Job	Employer Phone	Annual Gross Income$
Source of Additional Income (You need not furnish alimony, child support or maintenance income information if you do not want us to consider it in evaluating your application.)			Additional Income (amount per mo)

Spouse / Co-Applicant
First Name	Initial	Last	Date Of Birth	SS Number
Employer		Years On Job	Employer Phone	Annual Gross Income$
Source of Additional Income (You need not furnish alimony, child support or maintenance income information if you do not want us to consider it in evaluating your application.)			Additional Income (amount per mo)

Current Obligations
Name and Address of Creditor	Name Under Which Account is Carried	Account Number	Balance	Monthly Payment

Transfer Of Balance Request
I wish to transfer my present balance on the credit card account(s) listed to my new credit card. I understand that the unpaid balance on my credit card account being transferred must be within the credit line available on my new account.
Account No.	Amount to Transfer	Signature	Date

For Married Wisconsin Applicants Only
I certify that the credit being applied for, if granted, will be incurred in the interest of my marriage or family.
Signature	Date

For All Applicants
The undersigned give this information for the purpose of obtaining credit, certify that it is true and complete, authorize you to verify it, obtain additional information and to furnish credit information to others concerning my credit standing. By signing below, the undersigned agree to be bound by the Credit Card Agreement issued with the credit card. MARITAL PROPERTY INFORMATION: No provision of any marital property agreement, unilateral statement under 766.59 Wis. Stats., or court decree under 766.60, Wis Stats., adversely affects the interest of the creditor, unless the creditor, prior to the time the credit is granted or an open-end credit plan is entered into is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision.
APPLICANT'S SIGNATURE	Date
EMAIL ADDRESS
CO-APPLICANT'S SIGNATURE	Date
CO-APPLICANT'S EMAIL ADDRESS