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					INCREASE CREDIT LIMIT APPLICATION
MASTERCARD/VISA CLASSIC – VISA PLATINUM REWARDS (FORMALLY VISA GOLD)
    Last Four Digits of Existing Credit Card:                                                                                REFERRED BY:

    Credit Limit Increase – Amount Requested: $
    Other:
Check appropriate box:
   If you are applying for an individual account in your own name and are relying on your own income and assets and not the income and assets of another person as the
   basis for repayment of the credit requested, complete the Applicant information.
   If you are applying for a joint account or an account that you and another person will use, complete all sections, providing information in the Co-Applicant section.
   We intend to apply for joint credit (initial or sign).
Applicant X                                                Co-Applicant X                                             or Co-Signer X ____________________________

APPLICANT INFORMATION: All sections should be filled out completely. If not, processing of your application may be delayed.
 Last Name                              First                                   Middle                          Social Security Number
  Date of Birth                              No. of Dependents                       Home Phone                                            Own            Rent             Other      Mo. Payment ($)
  Street Address                                                                  City                           State                         Zip Code                               How Long (yrs)
  Previous Street Address                                                        City                            State                         Zip Code                               How Long (yrs)
  Employer                                                                        Self Employed            Yes         Employer Phone Number                                          How Long (yrs)
                                                                                                           No
  Address                                                                                                              Position/Occupation                                            Monthly Gross Income $
  Source of Additional Income *                                                                                        Amount per Month $
  Name and Address of Previous Employer                                                                                                                                               How Long (yrs)
  Nearest Relative (not living with you)                                                                                Phone Number                                                  Relationship
  Their Address                                                                   City                           State                         Zip Code

CO-APPLICANT/CO-SIGNER INFORMATION: Provide the following information only if co-applicant/co-signer is a joint applicant or will be an account user.
 Last Name                         First                                Middle                              Social Security Number
  Date of Birth                              No. of Dependents                       Home Phone                                            Own            Rent             Other      Mo. Payment ($)
  Street Address                                                                   City                              State                      Zip Code                              How Long (yrs)
  Previous Street Address                                                          City                              State                       Zip Code                             How Long (yrs)
  Employer                                                                          Self Employed              Yes      Employer Phone Number                                         How Long (yrs)
                                                                                                               No
  Address                                                                                                               Position/Occupation                                           Monthly Gross Income $
  Source of Additional Income *                                                                                         Amount per Month $
  Name and Address of Previous Employer                                                                                                                                               How Long (yrs)
* You need not furnish alimony, child support, or maintenance income information if you do not want us to consider it in evaluating your application.

  I authorize cards to be issued to the following user: Authorized User Name:________________________________________ Authorized User Signature X _________________________________
  I understand that I will be responsible for all charges made by the authorized user. Applicant Signature X ________________________________________________________________________


  NOTICE TO CO-SIGNER: You are being asked to guarantee this debt. Think carefully before you do. If the borrower does not pay the debt, you will have to. Be sure you can afford to pay if you have to, and that you want
  to accept this responsibility. You may also have to pay up to the full amount of the debt if the borrower does not pay. You may also have to pay late fees or collection costs, which increase the debt amount. The bank can
  collect this debt from you without first trying to collect from the borrower. The bank can use the same collection methods against you that can be used against the borrower, such as suing you, garnishing your wages, etc. If
  this debt is ever in default, that fact may become a part of your credit record. By signing below, you agree that you understand the responsibilities associated with co-signing this debt.
  Sign X_________________________________________                                                     Date ______/_______/_______

  ACCOUNT AGREEMENT (signature required): A condition of your credit card account is your granting us a security interest in your deposit accounts. By signing below you grant us a security interest in all individual and joint
  deposit accounts you have with us now and in the future to secure your credit card account. Shares and deposits in an Individual Retirement Account and any other account that would lose special tax treatment under state or
  federal law if given as security are not subject to this security interest. When you are in default, we may apply the balance in these deposit accounts to any amounts due under the credit card agreement..


  Sign X____________________________________________                                                                         Sign X______________________________________________
          Applicant Signature                                                         Date                                           Co-Applicant or Co-Signer Signature                                              Date



 Interest Rates and Interest Charges                                                                                                       Fees
 Annual Percentage Rate (APR)                                                                                                              Annual Fee
                                          10.25% when you open your account based on your                                                                                   $15.00 charged on anniversary date of the card.
 for Purchases/Balance Transfers
                                          credit worthiness. This APR will vary with the market based on the Prime Rate.
                                                                                                                                           Transaction Fees
 APR for Cash Advances                    10.25% this APR will vary with the market based on the Prime Rate.                                   • Cash Advance               • Either $5.00 or 3.00% of the amount of each cash advance,
                                                                                                                                                                              whichever is greater, with a maximum fee of $15.00.
 How to Avoid Paying Interest             Your due date is at least 25 days after the close of each billing cycle. Hills Bank will            • Foreign Transaction         • 1.0% when a currency conversion occurs. 0.8% when a
                                          not charge you any interest on purchases if you pay your entire balance by the due                                                  currency conversion is not performed.
 on Purchases
                                          date each month.
                                                                                                                                           Penalty Fees                     Penalty Fees
 Minimum Interest Charge                  If you are charged interest the charge will be no less than $0.50.                                  • Late Payment                • up to $27.00
                                                                                                                                              • Returned Payment            • up to $27.00
 For Credit Card Tips from the            To learn more about factors to consider when applying for or using a credit card, visit             • Returned Convenience        • up to $35.00
                                          the website of the Federal Reserve Board at http://www.federalreserve.gov/creditcard.                 Check Fee
 Federal Reserve Board
How we will calculate your balance: We use a method called “average daily balance (including new purchases)”
  PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING (signature required): This statement is submitted to obtain credit and I (we) certify that all information herein is true and complete. I (We) agree that inquiries
  may be made to verify information and that credit references or verification may be given based on inquiries from other parties. We may report information about your account to credit bureaus. Late payments, missed
  payments, or other defaults on your account may be reflected in your credit report. This offer is subject to the credit policies of this institution. I (We) agree to be bound by the terms and conditions of the bank card
  agreement, a copy of which will be mailed to me (us). If this application is granted, receipt of such agreement and acceptance of such terms to be conclusively presumed by the applicant’s use. If this is a joint application,
  the undersigned shall be jointly and severally liable for any and all credit extended from time to time.
  X _________________________________________________________________                                                    X   _______________________________________________________________
  Applicant Signature                                        Date                                                            Co-Applicant Signature                                Date

         FOR INTERNAL USE ONLY                            DATE APPROVED                                   CREDIT LINE                                     APPROVED BY                      VISA OR MASTERCARD ACCOUNT NUMBER

The credit terms are accurate as of the printing (8/10) of this application and are subject to change. Please submit inquiries to Hills Bank and Trust Company, 131 Main St, PO Box 160, Hills, IA 52235-0160.
Because rates and terms are subject to change, you may contact us for the current information by writing to the business reply address shown above.                                                  Rev. 8/10

				
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