FSBT Cash Back Rewards Credit Card Application

Are you an employee of First State Bank & Trust, Inc? *

YesNo

As an FSBT employee, you must submit a credit card application via Bridge It.

Go to Bridge It, Click on Weblinks then on Employee Credit Cards to apply. Thank you.

Which branch will be your primary banking location?*
Applicant Full Name*

First NameMiddle InitialLast Name
Applicant Social Security Number*
Applicant Date of Birth*

MonthDayYear
Date
Applicant Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Mother's Maiden Name*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
How long has applicant resided at this address?*
Current Monthly Mortgage / Rent Payment *
Employment Status*
Company Name
Occupation
Years Employed
Total Annual Income*
Total annual income can include wages, retirement income, investments, etc. Include personal and spousal/domestic partner income, if applicable. Alimony, child support or separate maintenance income does not need to be reported if you do not wish to have it considered as a basis for repaying the balance of this obligation. If applicant under 21: Only report income earned by applicant.
Add Authorized Signer*
You may request a card be issued on your account to a person you authorize to use your account. This person is called an Authorized Signer. You agree to be solely responsible for all transactions the Authorized Signer makes on your account.
Authorized Signer Name*

First NameLast Name
Authorized Signer Date of Birth*

MonthDayYear
Date
Authorized Social Security Number*
Mother's Maiden Name*
Authorized Signer Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Add Authorized Signer*
You may request a card be issued on your account to a person you authorize to use your account. This person is called an Authorized Signer. You agree to be solely responsible for all transactions the Authorized Signer makes on your account.
Authorized Signer Name*

First NameLast Name
Authorized Signer Date of Birth*

MonthDayYear
Date
Authorized Social Security Number*
Mother's Maiden Name*
Authorized Signer Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Add Authorized Signer*
You may request a card be issued on your account to a person you authorize to use your account. This person is called an Authorized Signer. You agree to be solely responsible for all transactions the Authorized Signer makes on your account.
Authorized Signer Name*

First NameLast Name
Authorized Signer Date of Birth*

MonthDayYear
Date
Authorized Social Security Number*
Mother's Maiden Name*
Authorized Signer Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Do you have a contact at a First State Bank & Trust branch?*

YesNoNot Sure
Please share who your FSBT branch contact is:
How did you learn about the FSBT Credit Card? (check all that apply)*

FSBT employee told me about itFriend/family shared it with meSocial media (Facebook, etc.)Google Search/Digital AdPrint/Radio/TV AdDirect Mail/Post CardEmailOther
Please see Terms and Conditions for rate, fee and other cost information, as well as an explanation of payment allocation. All terms may be subject to change.

https://www.fsbtrust.com/credit-card-cash-back-rewards-terms

Credit Card Privacy Policy -
https://www.fsbtrust.com/credit-card-privacy-policy

Credit Card Rewards Policy -
https://www.fsbtrust.com/rewards-policy
Applicant's Signature*

Digitally sign using your mouse or stylus.
Please verify that you are human*
Should be Empty: