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Applicant applies to UMB U.S.A.,n.a., Falls City, Nebraska, or its successors or assigns (“Issuer”) for an account as indicated above. If this application is accepted and credit card(s) issued, those signing above will be deemed to be in agreement with the terms and conditions accompanying the card(s). The Applicant in signing this form, certifies the information given herein to be true and correct and agrees to pay all charges on such account when due.The Applicant authorizes the Issuer to obtain and verify from time to time, credit, employment, and other information relating to the undersigned and to answer questions about the Issuer’s credit experience with Applicant. The Applicant acknowledges and agrees that such information may be used to establish, administer or collect the account requested by the undersigned for any legitimate purpose relating to the account. The Applicant understands that the Issuer will retain the application whether or not it is approved. Because this account is offered in conjunction with the State of Kansas, certain information about you and your use of the account will be supplied to your employer. By signing below, you consent to issuer sharing information you provide on your application and information about your account with your employer. Applicant agrees that unless they write to UMB U.S.A., n.a. at P.O.Box 13262, Kansas City, Missouri 64199, UMB U.S.A., n.a. and its affiliates may share information about the Applicant or the account for administrative purposes

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