Please Tell Us About Yourself (Authorizing Officer)
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Company Name Tax ID Number Applicant's Date of Ownership
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Physical Address City State Zip
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Mailing Address (if different from Physical Address) City State Zip
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Phone Number Fax Number
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Gross Annual Sales
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Current Business Checking Account Balance
Premier Business Visa® Application
Return this application via Fax: (210) 637-4811
or Mail application and fee (if applicable) to:
Farm Bureau Bank
P.O. Box 33427
San Antonio, TX 78265-9865
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Business Information
Requested Credit Line Amount: $_________________
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First Name MI Last Name Social Security Number
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Date of Birth Home Phone M