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Personal Information


Property Type*

Employment and Income

Rewards Enrollment

Enroll in Rewards?*

Joint Applicant Information


Property Type

Joint Applicant - Employment

Personal Reference

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.

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