Welcome to the Farmers Bank & Trust Credit Card Application! Please complete the application using the latest version of Safari, Mozilla Firefox, Google Chrome, or Microsoft Edge as your browser.

* Required Field

Personal Information

First Name*

Middle Name

Last Name*

Street Address*

City*

State*

Zip Code*

Date of Birth*

Mother's Maiden Name

Property Type*

Rent
Own/Mortgage
Board

Primary Phone Number*

Social Security Number*

Email Address

Income Verification

Present Employer (Company Name)*

Current Position*

Total Annual Income*

Other household income such as alimony, child support or separate maintenance income need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation.

Previous Employer (if less than 2 years at present)

Time There With This Company

Rewards Enrollment

Enroll in Rewards?*

Enroll
Do Not Enroll

Joint Applicant Information

First Name

Middle Name

Last Name

Street Address

City

State

Zip Code

Primary Phone Number

Date of Birth

Mother's Maiden Name

Property Type

Rent
Own/Mortgage
Board

Social Security Number

Joint Applicant Income Verification

Present Employer (Company Name)

Total Annual Income

Other household income such as alimony, child support or separate maintenance income need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation

If your creditworthiness does not meet requirements for the Farmers Bank & Trust Personal Credit Card, you will automatically be considered for the Farmers Bank & Trust Foundation Credit Card. If you wish to not be considered for this alternative product, please let us know by initialing below.

initial

Disclosure and Signature

Authorization: I certify that I am at least 18 years of age, and that I have read and agree to all the terms, authorizations and disclosures contained on the attached form and that everything I have stated in this certificate is true and correct. I authorize Farmers Bank & Trust Company to check my credit report and to verify my credit, employment, and income references. I understand that the use of any card issued in conjunction with this offer will constitute my acceptance of and will be subject to the terms and conditions of this Card Agreement. I understand that the terms of my account are subject to change as provided in this Card Agreement.

Applicant Signature*

Applicant Date*

Joint Applicant Signature

Applicant Date

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