1st Summit Bank - Business VISA Credit Card

888-262-4010 l www.1stsummit.bank

Member FDIC | Equal Housing Lender
Privacy Statement

Business VISA Credit Card

Submitter Information

First Name (required)

Last Name (required)

Resolve the errors marked in red before submitting again.

Business Name as you would like it to appear on the card

Tax ID Number

Legal Name of Business (if different from above)

Billing Address

Street Address Line 1

Street Address Line 2

City

State

ZIP Code

Street Address (if different from above)

Street Address Line 1

Street Address Line 2

City

State

ZIP Code

	Business Phone Number	Email Address	Years in Business
	(required)	(required)	(required)

Type of Business

Sole Proprietorship

General Partnership

Corporation

Limited Partnership

Limited Liability Company

Other (explain):

Nature of Business

	Loans Outstanding With	Purpose	Balance Due	Monthly Payment

	Deposit Accounts With	Type	Balance

I/We represent that all statements made by me/us in this application are true and correct. By typing your name on this application, I certify that I am of legal age and an owner, officer, or partner with the authority to bind the above entity to the terms and conditions of this Agreement. I/We authorize 1ST SUMMIT BANK to exchange credit information with others in connection with this application. I/We understand that the use of this line of credit is subject to terms and conditions as determined by the Bank from time to time. The Account Disclosure containing such terms and conditions will be provided to me/us after this application is approved. (required)

By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application. (required)

Applicant(s)

	Please type name below.	Work Title of Applicant(s)	Date of Application
	(required)	(required)	(required)

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