The First PREMIER Bank Gold Card Application

Do You Already Have a PREMIER Card? * Yes No

Tell Us About Yourself

Fields marked with an asterisk ( * ) are required.

Legal Name: First: * MI: * Last: *
Date of Birth: *
Social Security Number: * Why do we need this?
Check the box to see numbers as you type.
Street Address: *
City: * State: * Zip: *
Phone Number: *
Email Address: *
By providing your email address, you agree to receive electronic correspondence / advertisements from First PREMIER® Bank and PREMIER Bankcard®, LLC, even if you do not submit this application.

Additional Information

Do You Have a
Checking Account?: *
Yes No
Source of Income: *
Employer Info: Name: * Phone Number: *
Yearly Income: * Exact Income: * .00
Exact Income is only required if under $10,000 is selected for Yearly Income Before Taxes.
Additional Income Source: Exact Amount: * .00
You need not reveal alimony, child support or separate maintenance income if you do not wish to have them considered as a basis for repaying this obligation.
Want an Additional Card?: Yes No
Legal Name: First: * MI: * Last: *
Protect Your New Card
and Your Good Credit!: Yes! Please enroll me. No. Thank You.
Help me protect my account with PREMIER Credit Protection Plan. I am not interested in protecting my account with PREMIER Credit Protection.
PREMIER Credit Protection Disclosure Statement
TO ENROLL: Initialing here represents my signature and means that I wish to enroll in PREMIER Credit Protection. I understand the monthly cost of $0.89 per $100 outstanding balance will appear on my credit card statement. I acknowledge that I have read and agree with the costs, benefits, limitations and exclusions noted on the Disclosure Statement for PREMIER Credit Protection and I am free to cancel at any time. In CA, your signature on the enrollment form means that you have read and understand the Application of Cardholder information detailed below. You should read the disclosures before enrolling.
Important Notice: * By checking this box, I certify that I have read and agree to accept electronically First PREMIER Bank’s Privacy Policy.