HERE’S YOUR GOLDEN OPPORTUNITY TO
CARRY ONE OF THE WORLD’S MOST PRESTIGIOUS CARDS.
Gold MasterCard ® is honored by merchants, restaurants and
hotels throughout the world, and it’s serviced directly by us,
your hometown professionals. Don’t let this opportunity pass
you by. Complete this application and begin enjoying a new
world of prestige and purchasing power.
INCLUDED ADDITIONAL ADVANTAGES
LOST/DAMAGED LUGGAGE INSURANCE
When your luggage is lost or damaged, you are automatically
eligible to receive reimbursement for direct physical loss or
damage of baggage and personal property. This coverage
is provided for baggage checked by the card member on a
licensed common carrier, provided passage on the carrier is
charged to the credit card of your sponsoring institution. The
reimbursement coverage is provided free of charge.
TRAVEL/ACCIDENT INSURANCE
You are automatically covered by accidental death and dismemberment protection when traveling by air, bus, train, taxi
or any other common carrier anywhere in the world when you
use your card to purchase your tickets.
TRAVEL DISCOUNTS
You are guaranteed special savings on auto rental rates at
Avis, Hertz and National car rental companies in the U.S. and
many foreign countries. Simply present your Priority Travel
membership card when making reservations.
TRAVEL DIVIDENDS
Dividends are yours whenever you use your card to pay for
arrangements made through the Priority Travel Reservations
service. You’ll receive cash dividends on airline tickets, automobile rentals and lodging in addition to the savings through
best available fare or discount rate programs.
MULTI-CURRENCY CONVERSION RATES
If you effect a transaction with your MasterCard ® in a currency other than U.S. dollars, MasterCard ® International
Incorporated will convert the charge into a U.S. dollar amount.
MasterCard ® will use its currency conversion procedure, which
is disclosed to institutions that issue MasterCard ® cards.
Currently, the currency conversion rate used by MasterCard ®
to determine the transaction amount in U.S. dollars is either
a government mandated rate or a wholesale rate determined
by MasterCard ® for the processing cycle in which the transaction is processed, increased by an adjustment factor established by MasterCard ®. The currency conversion rate on the
processing date may differ from the rate on the purchase date
or cardholder statement posting date.
FREE INTERACTIVE WEBSITE
You can manage your credit card account online with mycardstatement.com. View balances, make payments, view reports
and statements, and download data to financial software.
Enroll at mycardstatement.com. It’s quick and secure.
CREDIT CARD REGISTRATION
All of your credit cards are registered at one time and one place.
Your confidential information is maintained in a high security
system. If any card is lost or stolen, all you do is dial a toll-free
number that’s available 24 hours a day, seven days a week. The
card will be reported, and the new cards will be requested. Safe,
convenient, secure.
AUTOMATIC HOTEL/MOTEL BURGLARY REIMBURSEMENT INSURANCE
When you are a registered guest of any hotel or motel in the
U.S. or Canada and have used the credit card of your sponsoring
institution to register and pay for your lodging, you are automatically covered up to $500 in the event of burglary. Under conditions detailed in your Description of Coverage, you are eligible
for reimbursement up to $500 ($200 jewelry) for amounts spent
to replace personal property lost through burglary of your room.
GROUP CREDIT CARD INSURANCE
Our Group Credit Card Insurance Program will make your
minimum monthly credit card payments if you, the Primary
Applicant, become totally disabled or involuntarily unemployed
for more than 30 days. In addition, this program will pay your
balance in full if either you or your Co-Applicant should die prior
to age 66. Benefits are payable up to a maximum of your balance at time of loss or $2,500, whichever is less. The cost of this
coverage is $0.59 per $100 of your outstanding monthly balance.
All coverage ends at age 66. In Colorado, to be eligible for this
insurance, you must be gainfully employed at least 30 hours per
week. In Colorado and Wyoming, your coverage does not terminate; instead, life coverage changes to Accidental Death and
Dismemberment at age 66.
DISCLOSURE STATEMENT
You are not required to purchase the Payment Protection Plan,
nor are you prohibited from purchasing insurance elsewhere
to receive an extension of credit from the bank. The Payment
Protection Plan is not a deposit of or guaranteed by the bank.
It is not insured by the bank, the FDIC or any other agency of
the United States. This program is offered and underwritten
by Central States Health & Life Co. of Omaha and Central
States Indemnity Co. of Omaha, both of Omaha, Nebraska.
A fee may be imposed by an ATM operator not holding the consumer’s account, or by any national, regional or local network
used to complete the transaction.
INFORMATION ABOUT OPENING AN ACCOUNT
The USA Patriot Act was enacted in an effort to protect you
and our country from threat of terrorism and terrorist activities.
Federal law requires all financial institutions to obtain, verify and
record information that identifies every person who opens an
account. This will aid in the government’s fight against money
laundering and the funding of terrorist activities. When you
open an account, we will ask for information that will allow us to
identify you. We may ask to see your driver’s license or other
identifying documents.
CREDIT APPLICATION
Member FDIC
GOLD
MASTERCARD®
mycardstatement.com
For a list of locations, visit pinnbank.com
ACCOUNT TYPE
(Check Only One)
INDIVIDUAL CREDIT - Relying solely on my income or assets
INDIVIDUAL CREDIT - Relying on my income or assets as well as income or assets from other sources
JOINT CREDIT - We intend to apply for joint credit (Initials) _____ _____
CREDIT APPLICATION
GOLD® MASTERCARD
CREDIT DISCLOSURES
ANNUAL
PERCENTAGE RATE
FOR PURCHASES,
CASH ADVANCE &
BALANCE TRANSFER
13.80%
GRACE
PERIOD
VARIABLE RATE
INFORMATION
The annual percentage rate may
vary semi-annually beginning april
1, 2010. The variable rate will BE
16% above the prime rate published
in the wall street journal on the 1st
day of the prior month. the variable
rate today, at maximum, would
be 19.25%.
25
DAYS*
METHOD OF
COMPUTING
THE BALANCE
FOR PURCHASES
TELEPHONE
PAYMENT
FEE
AVERAGE
DAILY
BALANCE
INCLUDING
NEW
PURCHASES*
$10 PER
OCCURRENCE
LATE
MINIMUM OVER LOST/
BALANCE
ANNUAL
CASH
CREDIT STOLEN TRANSFER
MEMBERSHIP PAYMENT ADVANCE FINANCE LIMIT
CARD
FEE
CHARGE
FEE
FEE
FEE
FEE
FEE
$30
$20
$0
$0
$0
$20
$0
The information about the costs of the card described in this application are accurate as of the REV date in the lower-left hand corner. The terms are subject to change after that date. For
current information on the costs of this card, contact: Pinnacle Bank, PO Box 461209, Papillion, NE 68046, (402) 339-3244 or 1-800-369-7283 (RATE).
*A Finance Charge will be imposed on Credit Purchases only if you elect not to pay the entire New Balance shown on your monthly statement for the previous billing cycle within 25 days from the closing
date of that statement. If you elect not to pay the entire New Balance shown on your previous monthly statement within that 25-day period, a Finance Charge will be imposed on the unpaid average daily
balance of such Credit Purchases from the previous statement closing date and on new Credit Purchases from the date of posting to your account during the current billing cycle, and will continue to accrue
until the closing date of the billing cycle preceding the date on which the entire New Balance is paid in full or until the date of payment if more than 25 days from the closing date.
The Finance Charge for a billing cycle is computed by applying the monthly Periodic Rate to the average daily balance of Credit Purchases, which is determined by dividing the sum of the daily balances
during the billing cycle by the number of days in the cycle. Each daily balance of Credit Purchases is determined by adding to the outstanding unpaid balance of Credit Purchases at the beginning of the
billing cycle any new Credit Purchases posted to your account, and subtracting any payments as received and credits as posted to your account, but excluding any unpaid Finance Charges. VISA® cards may
not be used for any illegal transaction.
APPLICANT
Note: All Sections Should be Filled Out Completely. If Not, Processing Of Your Application May Be Delayed.
Last Name
First
Date of Birth
No. of Dependents
Middle
Home Telephone
Own
Rent
Street Address
City
State
Employment
Self Employed?
Address
Position/Occupation
Yes
No
Social Security #
Other
Mo. Payments $
Zip Code
How Long (yrs)
Telephone Number
How Long (yrs)
Monthly Gross Income
Name and Address of Previous Employer
How Long (yrs)
Source of Additional Income*
Amount per Month $
Nearest Relative (Not Living With You)
Telephone Number
Relationship
Relative’s Address
City
State
Zip Code
* You need not furnish alimony, child support or maintenance information, if you do not want us to consider it in evaluating your application.
CO-APPLICANT
Note: Provide the Following Information Only if Co-Applicant is a Joint Applicant or Will Be an Account User.
Last Name
First
Date of Birth
No. of Dependents
Middle
Home Telephone
Own
Rent
Street Address
City
Employment
Self Employed?
State
Address
Position/Occupation
Yes
No
Social Security #
Other
Mo. Payments $
Zip Code
How Long (yrs)
Telephone Number
How Long (yrs)
Monthly Gross Income
Name and Address of Previous Employer
How Long (yrs)
Source of Additional Income*
Amount per Month $
* You need not furnish alimony, child support or maintenance information, if you do not want us to consider it in evaluating your application.
FINANCIAL REFERENCE
NAME OF INSTITUTION
DATE OPEN
AVERAGE BALANCE
ISSUER
CREDIT LIMIT
BALANCE
PAYMENT AMOUNT
TYPE OF DEBT
CREDITOR
ORIGINAL BALANCE
Checking Account
Savings Account
CD
Other
CREDIT CARDS
OTHER
PRESENT BALANCE
MONTHLY PAYMENT
1. Automobile
$
$
2. Mortgage
$
$
3.
$
$
4.
Are you a co-maker, endorser or
guarantor on any loan or contract?
Are there any unsatisfied
judgments against you?
Have you been declared
bankrupt in the last 10 years?
Yes
No
Yes
No
Yes
No
If “Yes,”
for whom?
To whom?
If “Yes,”
to whom owed?
Amount $
If “Yes,”
where?
Year
CREDIT CARD INSURANCE
Sign here to protect your account balance with Life, Disability, Unemployment and Family Leave Insurance by enrolling in the Optional Group Credit Card Insurance Program. I
acknowledge that I have read the Disclosure Statement on the reverse side of this application. Enrollment is voluntary and you are free to cancel at any time.
_______________________
Initial Here to Enroll
__________________
____________________________________
Birth Date
Print Name of Primary Applicant
NO, I do not want to protect
my account in the event of death,
disability or unemployment
Form C485 8/01
Policy Forms 10085 Rev/11006 Rev.
SIGNATURE(S)
PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING: This statement is submitted to obtain credit and I/we certify that all information herein is true and complete. I/We
agree that inquiries may be made to verify information and that credit references or verification may be given based on inquiries from other parties. This offer is subject to the credit policies of
this institution. I/We agree to be bound by the terms and conditions of the bank card agreement, a copy of which will be mailed to the applicant if this application is granted, receipt of such
agreement and acceptance of such terms to be conclusively presumed by the applicant’s use. If this is a joint application, the undersigned shall be jointly and severally liable for any and all
credit extended from time to time.
X
__________________________________________________________________________
Applicant Signature
REV. 11.09
Title
Date
X
__________________________________________________________________________
Co-Applicant Signature
Fold and secure with tape for mailing.
Title
Date
Member FDIC