iTHINK Financial Credit Card User Application – Revised – 2020-03-01 – Page 1 of 1
Member / Cardholder Name *
Member Number Loan Type
Residential Street Address (No Post Office Boxes)
Mailing Address (If different from above)
Security Password (For phone contact verification)
Social Security Number (Last 4 digits) Date of Birth
Home Phone Work Phone
Email Address
Cell Phone
Would you like to setup or make changes to your automatic payments or electronic statements?
Automatic
Repayment
Authorization
from
Account
Automatic Repayment Authorization Amount Options
[ ] Payoff Monthly Balance
[ ] Repay Minimum
Payment
eStatement Authorization
You may also like these services. Please contact us for details.
[ ] Overdraft for Checking
[ ] Credit Limit Increase
[ ] Payment Protection
[ ] Credit Monitoring
Member / Cardholder Signature * Date
Authorized User Name *
Member Number
Social Security Number (Required) Date of Birth
Security Password (For phone contact verification)
Name on Card (Not to exceed 26 Characters)
Residential Street Address (No Post Office Boxes)
Mailing Address (If different from above)
Home Phone Work Phone
Email Address
Cell Phone
Authorized User Signature * Date
LIABILITY: Authorized Users must be at least 16 years old. The Member / Cardholder is responsible for payment of all transactions made by the
uthorized User. In accordance with Federal Law and the USA PATRIOT Act, all financial institutions are required to obtain, verify, record and retain
nformation that identifies every person doing business at or through their institution. In processing your request, we require your legal name,
axpayer Identification Number (TIN), residential and mailing addresses, date of birth, and any other information that will allow us to identify you. We
lso require clear and legible photocopies of at least one (1) form of unexpired government issued photo identification from you and the
uthorized User(s) on your credit card loan account(s). The identification and information that you and any Authorized Users provide will be verified
s part of our loan qualification process, which may include credit and debit bureau inquiries. For more information, please refer to our Credit Card
greement and Disclosures, available upon request or on our website at ithinkfi.org.
Please return the signed and completed form along with copies of your identification to your local Branch or to iTHINK Financial Loan Operations.
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