Premier Platinum Card Application

01

Personal Information

Applicant Details

Title

First Name *

Middle Name

Last Name *

Date of Birth *

Gender *

Nationality *

02

Contact Information

Communication Details

Email Address *

Phone Number *

Residential Address *

Mailing Address

03

Card Selection

Platinum Card

Premier Platinum Premium card option

Apply for the Premier Platinum card and review the applicable product terms, fees and eligibility requirements.

Additional Card Subject to eligibility

Request consideration for an additional Premier Platinum card where the applicable product terms permit.

04

Identification

Verification Details

Identification Type *

Identification Number *

Existing Member / Account Number

Identification Document

JPG, JPEG, PNG or PDF. Maximum recommended size: 5MB.

Proof of Address

JPG, JPEG, PNG or PDF. Maximum recommended size: 5MB.

05

Employment & Income

Financial Information

Employment Details

Employment Status *

Employer / Business Name

Occupation

Employment Duration

Estimated Monthly Income

Amount

Other Monthly Income

Amount

06

Card Preferences

Application Preferences

Preferred Card Limit *

Option 1 Subject to approval

Option 2 Subject to approval

Option 3 Subject to approval

Preferred Statement Delivery *

Intended Card Usage

07

Emergency / Contact Person

Optional

Full Name

Relationship

Phone Number

Email Address

08

Additional Information

Optional

Application Review

Submission of this application does not constitute approval or guarantee issuance of a Premier Platinum Card. Applications may be subject to identity verification, eligibility assessment, credit assessment and the applicable product terms and conditions.

I confirm that the information supplied in this application is accurate and complete to the best of my knowledge. I authorize Gent Credit Union to verify the information provided as permitted by applicable requirements. I understand that card issuance, limits, fees and other conditions are subject to the applicable product terms, eligibility requirements and approval process.

Apply for Your Premier Platinum Card