Credit Builder Savings Account Application

Needed to Apply

Drivers License or Government-Issued ID
Social Security Number
Date of Birth
Current Home Address
E-mail Address

Your personal information is confidential and secure with Academy Bank. We will not share your personal information without your permission.

You are applying for a secured credit card, a product designed to help establish or rebuild credit.

You will need to deposit an amount into a savings account equal to the credit limit you are requesting. You can request an amount from $300 up to $3,000.

As an example, if you are applying for a $500 Secured Credit Card, you will need to deposit $500 into a savings account. You will then be expected to make monthly payments equal to at least the minimum payment amount shown on your monthly statement.

Important Information

To help the government fight the funding of terrorism and money laundering activities, U.S. Federal Law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. As you open an account, we will ask you for your name, address, date of birth and other information that will allow us to identify you. We may ask to see your drivers license or other identifying documents. Legal Entities may be required to certify ownership and managerial control information.

1 2 3 4 5

Page 1 of 5

Ownership *

Single

Joint

Primary Applicant Information:

First Name *

Middle Name

Last Name *

E-mail *

Confirm E-mail *

Date of Birth *

Month

Day

Year

Primary Phone *

Other Phone

Residential Status *

Own

Rent

Other

Years at Current Address *

Monthly Rent or Mortgage *

Address 1 *

Address 2

City *

State *

ZIP code *

Address *

Same as Mailing Address? *

Yes

Country

Address 1

Address 2

City

State

ZIP code

Mailing Address

Primary Applicant Liability

Current Monthly Auto Loan Payment(s)

Current Monthly Credit Card Payment(s)

Current Monthly Child Support Obligations

Current Monthly Alimony Obligations

Co-Applicant

First Name *

Middle Name

Last Name *

E-mail *

Confirm E-mail *

Date of Birth *

Month

Day

Year

Co-Applicant Liability

Current Monthly Auto Loan Payment(s)

Current Monthly Credit Card Payment(s)

Current Monthly Child Support Obligations

Current Monthly Alimony Obligations

Security Data

Why do you need to provide this information? ¹
This information will be used for additional account verification purposes once your account has been established. It is used to identify you when you use forms on our website.

Place of Birth *

Country of Citizenship *

Mother's Maiden Name *

Identification *

State Driver's License

State-Issued ID

Military ID

Passport

State Driver's License Info

State of Issuance *

Driver's License Number *

Expiration Date *

Month

Day

Year

State ID Info

State of Issuance State ID *

State ID Number *

State ID Expiration Date *

Month

Day

Year

Military ID Info

Branch of Service *

Military ID Number *

Military ID Expiration Date *

Month

Day

Year

Rank

Passport Info

Passport Number *

Passport Issuing Authority *

Issued Date *

Month

Day

Year

Expiration Date *

Month

Day

Year

Employment Status Info

Employer *

Business Name *

Job Title *

Work Phone *

Work E-mail *

Former Employer *

Former Job Title *

Employment Status Details *

Gross Income From Employment

Your Annual Income *

Other Annual Income

Total Annual Income *

Nearest Relative

This information will be used only if there is an issue with your account and we are not able to reach you.

Full Name *

Relationship *

Phone *

Address 1 *

Address 2

City *

State *

ZIP code *

Address *

Checking

Savings

Online Banking

Mobile Banking

HOW’S YOUR CREDIT? CHOOSE THE CARD THAT FITS YOUR NEEDS.

Personal Loans

Secured Personal Loans

Home Equity Loans

Mortgages

Managing Accounts

Understanding Finances

Banking Safely and Securely

Homeownership

Credit Builder Savings Account Application

Needed to Apply

Primary Applicant Information:

Security Data