Card Information

Card Type  * Disclosures

United Bank VISA Classic Card

United Bank VISA Gold Card

Limit Requested

Account Number

Personal Information

* Required Fields

 

First Name:

*

Middle Initial:

*

Last Name:

*

Social Security Number::

*

Marital Status:

Married

Unmarried

Legally separated

Notice to Married Applicants: No provision of any marital property agreement, unilateral statement under s.766.59 Wisconsin statutes, or court decree under s.766.70 Wisconsin Statutes, 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 position.

Is there a marital property agreement?

Yes

No

has lender received a copy of the marital property agreement?

Yes

No

Driver’s License:

*

Birth Date:

Home Address:

City:

State:

Zip:

*

*

*

*

*

How long?

If you’ve lived at your current address less than two years, please provide your previous home address:

Previous Home Address:

City:

State:

Zip:

E-mail address:

Home phone number:

Employment Information

Work phone number: