Apply Now—Check Card

* = Required Field
 

Last Name*:	First Name*:	Middle:
Social Security Number*:	Home Phone:	Business Phone:
Current Address*:	City :	State: TN	Zip Code :
How Long (Years.)
Mailing Address (if different from above):	City:	State:	Zip Code:
Previous Address:	City:	State:	Zip Code:
Email Address*:
Employed By :	Position:	How Long:
Annual Household Income:	Employer's Address:	City:
State:	Zip:
Nearest Relative (Not Living With You):	Address:
Credit Reference (If new checking account):
Bank Name:	Address:	Account Number:
PLEASE FILL IN THE PRIMARY CHECKING ACCOUNT NUMBER BELOW. tHIS IS THE ACCOUNT THAT ALL PURCHASES WILL BE DEBITED FROM. IF YOU WANT TO INCLUDE YOUR MONEY MARKET SAVINGS OR ANY OTHER CHECKING ACCOUNTS FOR THE ATM, PLEASE ENTER THEM IN ANY ADDITIONAL ACCOUNTS BELOW.

Wilson Bank and Trust ATM Card #:  (Last 7 Digits) *If you currently have one. This one will be closed when new card arrives.
Primary Checking Account #:
Primary Money Market Savings #:
PIN Number Selected (4 Numbers):
ANY ADDITIONAL ACCOUNTS: INCLUDE ACCOUNTS TO ACCESS THROUGH TELEPHONE BANKER
Type	Account #
PLEASE READ BEFORE SIGNING I understand that this is not a credit card application. I have answered the questions in this application fully and truthfully, and all information provided is correct. I authorize you to obtain information to check my credit records and statements made in this application. I understand that if approved, cards will be mailed to the address listed on my Wilson Bank & Trust checking account. The use of such Card shall be governed by the printed terms and conditions of THE AUTOMATED TELLER MACHINE CARDHOLDER AGREEMENT and such other terms and conditions or amendments thereto, as may be established by Wilson Bank & Trust and communicated in writing to me.
Signature:	Date: