Consumer Credit Card Application

Please fill out this secure form.
*Indicates a Required Field
Credit cards will only be issued to U.S. citizens or permanent resident aliens of the United States of America.

Application for:*
PLATINUM
WORLD

Select only if annual purchases (excluding cash advance/balance transfers) will exceed $10,000.
WORLD ELITE

Select only if annual purchases (excluding cash advance/balance transfers) will exceed $40,000.
Applicant Information (Applicant, if married, may apply for separate account.)
Request Card Activation for use in Cuba?*
Please refer to our ďTraveling to Cuba?Ē section on the website for the Personal Compliance Certification Form that needs to be completed.

Yes
No

Have you ever declared bankruptcy?*

Yes
No
Have you ever been declined credit from Stonegate Bank?*

Yes
No
Resident Status:*

U.S. Citizen
Permanent Resident Alien
Non:Resident Alien
Main Applicant

 
   
Identification Type:*  Driverís License  Passport  U.S. Permanent Resident Card 
         
Employment Status:*   Employed  Military  Retired  Student  Other  Unemployed 
Alimony, child support and other separate maintenance income need not be revealed if you do not wish to have it considered as part of your application.
Include an estimate of what you are personally required to pay on a monthly basis, including rent/mortgage, utilities and other expenses, etc.
Applicant Sign Here

I hereby certify that all the above statements and the information on this Application form are submitted for the purpose of obtaining credit. I, as the Applicant, certify that the information given is true and correct, and authorize Stonegate Bank (Issuer) to obtain all credit information necessary to process this application. I authorize Issuer to check with credit reporting agencies and other sources for any lawful purpose in connection with this application and any account. I agree to the terms and conditions contained in the Cardholder Agreement to be furnished to me with my credit card(s), if credit is approved. I understand the Issuer will request information from me to verify my identity in accordance with the USA Patriot Act. I understand that I will be liable for the payment of all balances on any authorized user account opened pursuant to this application.




If you have questions regarding your credit card application please contact your local branch, relationship manager, or email us at stonegatecardservices@stonegatebank.com. Please do not email any personal information that is not secure and encrypted.

Authorized Users (Name to Appear on Card)

User 1 Information

User #1 - Required


   
Identification Type:*  Driverís License  Passport  U.S. Permanent Resident Card 
         
 
Resident Status:*   U.S Citizen  Permanent Resident Alien  Non-Resident Alien 


User 2 Information

User #2 - All fields are required if name entered


   
Identification Type:  Driverís License  Passport  U.S. Permanent Resident Card 
         
 
Resident Status:  U.S Citizen  Permanent Resident Alien  Non-Resident Alien 


User 3 Information

User #3 - All fields are required if name entered


   
Identification Type:  Driverís License  Passport  U.S. Permanent Resident Card 
         
 
Resident Status:  U.S Citizen  Permanent Resident Alien  Non-Resident Alien 


User 4 Information

User #4 - All fields are required if name entered


   
Identification Type:  Driverís License  Passport  U.S. Permanent Resident Card 
         
 
Resident Status:  U.S Citizen  Permanent Resident Alien  Non-Resident Alien 


User 5 Information

User #5 - All fields are required if name entered


   
Identification Type:  Driverís License  Passport  U.S. Permanent Resident Card 
         
 
Resident Status:  U.S Citizen  Permanent Resident Alien  Non-Resident Alien 


User 6 Information

User #6 - All fields are required if name entered


   
Identification Type:  Driverís License  Passport  U.S. Permanent Resident Card 
         
 
Resident Status:  U.S Citizen  Permanent Resident Alien  Non-Resident Alien 




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