Visa Platinum Credit Card

• Credit Limit Requested (minimum of $500.00)
  OK Credit Limit Requested (minimum of $500.00) is required

• Do you currently have a checking account with our institution?

  • Yes
  • No
  OK Do you currently have a checking account with our institution? is required

Personal Information:

• First Name
  OK First Name is required
• Middle Name
  Optional OK Middle Name is required
• Last Name
  OK Last Name is required
• Social Security Number
  OK Social Security Number is required

• Date of Birth

  JanFebMarAprMayJunJulAugSepOctNovDec 12345678910111213141516171819202122232425262728293031 20242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900
  OK Date of Birth is required
• No. of Dependents
  OK No. of Dependents is required
• Home Phone
  OK Home Phone is required
• Cell Phone
  Optional OK Cell Phone is required
• Mother's Maiden Name
  OK Mother's Maiden Name is required
• Email
  OK Email is required
• Nearest Relative (Not living with you)
  OK Nearest Relative (Not living with you) is required
• Home Phone
  OK Home Phone is required
• Relationship
  OK Relationship is required

Privacy Policy

• • By clicking this box I agree that I have read and agree to the Privacy Policy
  OK By clicking this box I agree that I have read and agree to the Privacy Policy is required

Fidelity Bank Credit Card Agreement

• • By clicking this box I agree that I have read and agree to the Fidelity Bank Credit Card Agreement
  OK By clicking this box I agree that I have read and agree to the Fidelity Bank Credit Card Agreement is required

Consumer Interest Rates and Interest Charge Disclosure

• • By clicking this box I agree that I have read and agree to the Consumer Interest Rates and Interest Charge Disclosure
  OK By clicking this box I agree that I have read and agree to the Consumer Interest Rates and Interest Charge Disclosure is required