NEWFIELD NATIONAL BANK -- VISA BUSINESS CREDIT CARD APPLICATION
Request Type (Select One) ○ New Account ○ Line Increase Credit Line Credit Limited Requested: $ Billing Option (New Accts) ○ Revolving (R) ○ Pay In Full (P)
Business Information
Legal Name of Business Business Physical Address (No P.O. Boxes) City, State, Zip Business Phone Number Business Name to Appear on Card (24 characters or less) Business Mailing Address City, State, Zip Business Fax Number
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Tax ID Number Legal Structure (Pick One) ○ Sole Prop ○ Corporation ○ S Corporation ○ Partnership ○ LLC ○ Other: Business Gross Annual Sales
Month/Year Business Established Non-Profit? ○ No ○ Yes, include last two years financial statements, and copy of minutes showing authorization to apply. Number of Employees
$
Nature of Business (Goods or Services provided)
Contact Information
This person will be authorized to obtain account information, as well as make changes to the account. Changes include, but are not limited to, address changes and addition/deletion of cardholders. It is the responsibility of an authorized party to inform Creditor of any changes to the contact person. (Limit Increase(s) must be requested by all authorized parties in writing and may required additional documentation, such as updated financials statements.) Contact Name Contact Title Contact Phone Number Contact Signature (to verify future correspondence)
Principal/Owner/Member/Guarantor Information
All owners of 10% or more, all partners and all members must complete this section and must guaranty this credit. Creditor may request financials and operating agreements. Authorized Party #1 Name (First, MI, Last) Home Address (No P.O. Boxes) City, State, Zip Authorized Party #2 Name (First, MI, Last) Home Address (No P.O. Boxes) City, State, Zip Authorized Party #3 Name (First, MI, Last) Home Address (No P.O. Boxes) City, State, Zip Authorized Party #4 Name (First, MI, Last) Home Address (No P.O. Boxes) City, State, Zip Title Home Phone Number Percentage of Ownership
%
Annual Salary
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$
Date of Birth
Social Security Number
Title Home Phone Number
Percentage of Ownership
%
Annual Salary
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$
Date of Birth
Social Security Number
Title Home Phone Number
Percentage of Ownership
%
Annual Salary
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$
Date of Birth
Social Security Number
Title Home Phone Number
Percentage of Ownership
%
Annual Salary
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$
Date of Birth
Social Security Number
Cards To Issue
(Cardholders that are not an Authorized Party shown above, bear no financial responsibility for repayment to the Creditor) (SSN used as proof of identity only) Cardholder’s Name (How it will appear on card) How many generic cards Credit Limit Cash Limit Billing Option Card #1 $ $ ○ (R) ○ (P) CORPORATE CARD Card #2 Card #3 Card #4 Cardholder Name(s) (How it will appear on card) Cardholder Name(s) (How it will appear on card) Cardholder Name(s) (How it will appear on card) Social Security No. Social Security No. Social Security No. Credit Limit $ Credit Limit $ Credit Limit $ $ Cash Limit $ Cash Limit $ Cash Limit $ Billing Option ○ (R) ○ (P) Billing Option ○ (R) ○ (P) Billing Option ○ (R) ○ (P)
Must be equal to or less than total limit requested
BY SUBMITTING THIS APPLICATION The individuals (“you”) signing below acknowledge and agree to all the Terms and Conditions set forth in this application, (front and back) and sent to you upon card issuance. You also certify that you have the authority to make this application for the business listed and all information and documents submitted are verifiable and accurate. You understand that the creditor may ask for additional identifying documents from you and the business to assist with credit decisions and cooperate with the US Patriot Act. You authorize the creditor to obtain your personal credit report and to provide credit information to credit bureaus about you if applicable. PAYMENT You acknowledge that if you selected a revolving payment plan and do not qualify you will automatically be setup as a pay-in-full account. GUARANTY By signing below, each individual jointly, separately and unconditionally guarantees payment of and agrees to pay creditor for all charges and balances on all accounts established with this application. Under this Guaranty, the liability of Guarantor(s) is unlimited and the obligations of Guarantor are continuing, including any future credit limit increases.
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Applicant/Authorized Party #1, As Principal/Owner/Member And Individually as Personal Guarantor
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Applicant/Authorized Party #2, As Principal/Owner/Member And Individually as Personal Guarantor
X
Applicant/Authorized Party #3, As Principal/Owner/Member And Individually as Personal Guarantor
X
Applicant/Authorized Party #4, As Principal/Owner/Member And Individually as Personal Guarantor
NEWFIELD NATIONAL BANK VISA BUSINESS CARD DISCLOSURE
Rates & Fees
Annual Percentage Rate (APR) for Purchases/Balance Transfers Other APR’s Grace Period on Purchases Balance Calculation Method Balance Transfer Fee Cash Advance Fee Late Payment Fee2 Over Limit Fee3 Return Payment Fee
1.
11.99% Fixed
Cash Advances: 11.99% Default Rate1: 19.99% APR’s FIXED 25 Days Average Daily Balance (including new purchases) $0.00 3% ($5.00 Min $20.00 Max) 5% ($5.00 Min $20.00 Max) $20.00 (when limit is exceeded by $50.00) $20.00
2.
3.
Your purchase, balance transfer, and cash advances rates will adjust to the default rate if you are late three times in a six-month period. A restored fixed rate after default may range from 11.99% to 15.99%. This fee is applied if the minimum required payment is not received within 15 days after the closing date subsequent to the payment due date. This fee is applied if you exceed your credit limit by $50.00.
The information in this application is accurate as of March 2006 and is subject to change after that date. For current information call our Card Services Department at 1-800-690-3440.
Benefits
Direct from Newfield National Bank • • • • • • • NO ANNUAL FEE! Reward Points, $1.00 = 1 Point (Qualified Purchase Dollars only) Monthly, Quarterly, and Annual Management Reports Separate Credit & Cash Limits for each Cardholder Travel Accident Insurance Travel Advantage Program (including Auto Rental Insurance) Warranty Services www.visa.com/benefits
Direct from Visa (1-800-VISA-911) • • • • •
Auto Rental Collision Damage Waiver Emergency Card Replacement and Emergency Cash Disbursement Purchase Security and Extended Protection Travel & Emergency Services Visa Liability Waiver Program