Spacer Image
Spacer Image
Spacer Image
Spacer Image
Spacer Image
Spacer Image

Platinum Mastercard Application
Spacer Image
Spacer Image
Spacer Image
MasterCard® Application

To apply please complete the following information, print and mail the form below to:

CVNetCenter™
Cumberland Valley National Bank
PO Box 709
London, KY 40743-0709
Attn: Automated Services

Or leave the form with a customer service representative at any CVNB location.

We cannot accept enrollment via e-mail or fax because we require original signature(s) on the application form.

Please complete all portions of the application to avoid delays in processing.

Platinum Card Gold Card Classic Card
Applicant Information
First Name
Middle Initial
Last Name
Birthdate
Number of Dependents
Current Address
City
State
Zip
Do you?
Monthly Rent/Mortgage
Time at Current Address
Home Phone
Social Security Number
Previous Home Address
(if current address is less than one year)
City
State
Zip
Time at Address
Employer
Occupation
Gross Income
Employer Address
Business Phone
Station No
Badge No
Length of Employment
Previous Employer (if current is less than one year)
Occupation
Address
Length of Employment

Credit Reference 1
Name
Address
Balance Due
Monthly
Payment
Credit Reference 2
Name
Address
Balance Due
Monthly
Payment
Credit Reference 3
Name
Address
Balance Due
Monthly
Payment
Credit Reference 4
Name
Address
Balance Due
Monthly
Payment
  
Checking Account with
Account Number
Savings Account with
Account Number
Auto Financed By
Make & Year
Presently have cards with
Other Income - Source*
Name of Relative not living with you
Address
City
State
Zip
Relationship to You

If you and another person wish to have a joint MasterCard account (that is, you will both use or be contractually liable upon the same account) please provide us with the following information, and ask him or her to sign below next to your signature

Co-Applicant

First Name
Middle Initial
Last Name
Co-Applicant's Current Address
City
State
Zip
CO-Applicant's Social Security Number
CO-Applicant's Employer
Position/Title
Employer Phone
Length of Employment
Net Income
CO-Applicant's Previous Employer

*Income from alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis of repaying this obligation

Undersigned hereby authorizes you or any credit bureau or other investigative agency employed by you to investigate any reference given by undersigned or statement or other data obtained from undersigned or from any other person pertaining to undersigned's credit and responsibility. Undersigned also authorizes you to furnish to other persons, upon request, information concerning undersigned's credit and financial transactions or experiences with the bank. 2 Signatures Required for 2 Cards to be Issued

  
Applicant Signature: _____________________________________
Date of Application: _____________________________________
  
Co-Applicant Signature  (if joint credit sought):_____________________________________
Date of Application: _____________________________________
  
Requested Credit Line Amount
 
                      
 

For Bank Information Only:

 Agent        CL      

EXP             No. of Cards  

Date            CYC  

 
Top of Page
 
Spacer Image
Spacer Image Home | Bank Safety & Identity Protection | Privacy Policy | Contact Us
Member FDIC | Equal Housing Lender Equal Housing Lender Logo
Spacer Image