Welcome to Fortiva Credit Card
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1 Pre-qualify 2 3
Please review the SUMMARY OF CREDIT TERMS which summarizes the key terms of the Cardholder Agreement that will govern your Fortiva Credit Card account. I understand that prequalification does not guarantee final approval.

Complete the following form (all asterisked *fields are required) so we can process your pre-qualification quickly.

Personal Information

Contact Information

Residence Information

Residence Details

Employment Information

Alimony, child support or other maintenance income need not be included in Annual Gross Income if you don't wish to have them considered as a basis for repaying your loan obligation.
Married Wisconsin Residents: Combine you and your Spouse's information on this form.

State Law Notices

California Residents: If married, you may apply for a separate account.

Delaware Residents: Service charges not in excess of those permitted by law will be charged on the outstanding balances from month to month.

Maryland Residents: Finance charges will be made in an amount or at rates not in excess of those permitted by law.

Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio civil rights commission administers compliance with this law.

Married Wisconsin Residents: No provision of a marital property agreement, a unilateral statement under section 766.59 or a court decree under section 766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred. We are required to ask you to provide the name and address of your spouse.

By checking the box at the left, you certify that you have read, retained and agree to the Consent to Electronic Disclosures.



I understand that by clicking "See Offer" below, I am providing "written instructions" to The Bank of Missouri, its successors, assigns and agents (collectively, the "Lender") to obtain an initial report (soft inquiry) from a consumer reporting agency in accordance with the federal Fair Credit Reporting Act to conduct a prequalification review.