Credit Card Application (Required fields are in bold )

I am applying for an EastWest Bank If we are unable to process your application for a Gold card,
MasterCard would you be willing to receive a Silver Card?

Silver Gold Yes No

** Annual fee is waived for the first year. **

Your Personal Details

Others
Where did you hear about EastWest Bank MasterCard?
Agent - N. Gabrieles
Others
Name

First Middle Last

Card Name
(Name to appear on card, max 19 chars)
Mother's Full Maiden
Name
Email Address

Birthdate
(MM/DD/YYYY)
Gender
Male Female
Civil Status
Single Married Widowed Separated
No of Dependents

Nationality

Educational Attainment
High School Some College College Post Graduate
TIN

SSS No
Home Address

Zip Code

Years of Stay

Home Phone
Format: (Area Code) + Phone Number
Mobile Phone
Home Ownership
Owned/Not Mortgaged Owned/Mortgaged Parents/Relative Owned

Rented Company Provided

Number of cars owned
Spouse Details
Full Name
(First, Middle, Last)
Company/Business Name
 Business Address

Zip Code

Business Phone
Format: (Area Code) + Phone Number
Gross Annual Income

Your Personal Reference

Full Name
(Relative/Friend)
Company/Business Name
Business Address

Zip Code

Business Phone Format: (Area Code) + Phone Number

Your Personal Reference

Full Name
(Relative/Friend)
Company/Business Name
Business Address

Zip Code

Business Phone Format: (Area Code) + Phone Number

Work and Finances

Employment
Self-employed Government Private Sector Retired

Years with present employer/business

Position
Clerk OCW

Officer - Junior/Supervisor Religious

 Officer - Senior Retired

Executive Self-Employed/Proprietor

Non-Officer (Lawyer, Teacher) Other:

Nature of Business
Agricultural/Mining Manufacturing

Banking Real Estate

Business/Commercial Services Transportation/Communication

Community/Social/Personal Utilities

Financing Wholesale/Retail/Food/Business

Insurance Other:

Construction
Occupation
Administrative/Executive Professional/Technical

Agricultural Sales Worker

Armed Forces/Military Service Worker

Clerical Self-Employed

Product/Transport Other:
Company / Business Name

Business Address

Zip Code

Business Phone

Gross Annual Income

Are you an existing
EastWest Bank Depositor? Yes No

if yes, Account No.

Your Other Credit Cards

Card Issuer - Please Select -

Card Number

Member Since

Credit Limit

Card Issuer - Please Select -

Card Number
 Member Since

Credit Limit

Card Issuer - Please Select -

Card Number

Member Since

Credit Limit

Billing Preference
Billing/Card Delivery
Home Office

I, _______________________________________confirm that the information given by me is true and correct. I

authorize EastWest Bank to verify and investigate such information from whatever sources it may consider
appropriate. I understand that falsifying any of the information on the submitted documents is sufficient
ground for the cancellation of my card. I understand that should my application be denied, EastWest Bank has
no obligation on its part to furnish the reason for such rejection. In the event of any future delinquency, I
hereby authorize EastWest Bank to report and/or include my name in the negative listings of any credit
bureau or institution. I acknowledge that my use of the Card and my signature at the back of the Card signify
my agreement to be bound by the terms and conditions applicable to the use of the Card.

_______________________________________
Signature over printed name/Date