Applicant Info

Next: Current Address

Applicant Information

Note: All applicable sections should be filled out completely to avoid delay in processing your application.

 Referred By A Prairie State Bank & Trust Employee?

Please let us know the name of any one of our employees that might have discussed and shared in the benefit of our credit card with you.

Name of employee

Type of Application * --Select One-- New Applicant Credit Line Increase

Last Name *

First Name *

Middle Name *

Suffix

Social Security Number * *

Date of Birth *

Cell Phone * *

Alternate Phone *

Email Address * *

Important information about procedures for opening a new account - To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.