Account Product Transfer

I (we) agree to the terms and conditions contained in the Cardholder Agreement to be furnished to me (us) with my (our) new credit card(s). I (we) understand the Issuer may request information from me (us) to verify my (our) identity in accordance with the USA Patriot Act.  I (we) understand that I (we) will be liable both individually and jointly for the payment of all balances on any authorized user account opened pursuant to this account.

Applicant’s Name: ________________________________________________________________________________________________________ 

                                                                           (Please Print First and Last Name)

Applicant’s Signature: ________________________________________________    Date (mm/dd/yyyy) _____________________________

Co-Applicant’s Name:_______________________________________________________________________________________________________________________

                                                                          (Please Print First and Last Name)

Co-Applicant’s Signature: __________________________________________________________ Date (mm/dd/yyyy)___________________ 

Your Signature Affirms Your Intent to Transfer Products.

 Provide Your Current Account Number to be transferred in the Box Below:

Please fax a signed copy of this document to 770-805-2173 or scan and email a copy to [email protected].