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Application Information

Name & Address Fields marked as * are required.
First Name * MI  Last Name * Suffix Date of Birth * Social Security Number*
  / / --
Home Phone * Work Phone Mobile Phone
() - () - () -
Email Confirm Email  Disclosure Mother's Maiden Name *
Providing this information above is my express written consent for Merrick Bank to contact me, including by use of auto-dialers and other automated means, in connection with my Account, at the phone numbers and email address provided by me.
Is your address the same as it appears on your Acceptance Certificate? Yes   No
Financial Information
Gross Annual Income *
Source of Income *
Explain Source of Other Income *
Alimony, child support, or separate maintenance income need not be disclosed unless you want it to be considered as a basis for determining creditworthiness.
Annual income information should be reported as gross income.
Authorized User
Would you like to add an authorized user?* Yes!   No, thanks.
Security Deposit Funding Options*

Pick your Security Deposit amount $ ($200 minimum up to $3,000 maximum).

Security Deposit funding details will be provided at the end of your application. Your credit line will equal your Security Deposit we receive. Security Deposits less than $200 and more than $3,000 will be returned.

Your Bank's Online Payment Service Use your payment service to have funds electronically routed to Merrick Bank. Note, you may need to add Merrick Bank as a payee.

Please check with your bank to see how funds will be remitted. Your bank may send a paper check instead of electronic funds, which may delay your deposit.
MoneyGram Money Transfer Visit any MoneyGram® location and have your funds electronically routed to Merrick Bank.
Western Union Money Transfer Visit any Western Union® location and have your funds electronically routed to Merrick Bank.
United States Postal Service Simply mail your Security Deposit Coupon along with your check or money order.
E-Sign Disclosure and Consent
By clicking here, I confirm to you that: *
  • I have accessed and read this "E-Sign Disclosure and Consent;"
  • I can print the disclosure on paper or save or send the disclosure to a place where I can print it, for future reference and access; and
  • Until or unless I notify Merrick Bank as described above, I consent to receive from you all Communications through electronic means.
Cardholder Terms and Conditions
Merrick Bank will establish your initial credit limit and mail you the card(s) you request ("Card(s)") upon approval of your Online Application, in accordance with the terms set forth below. You agree that if you sign the Card(s) or use your Account or the Card(s) to obtain credit, that will constitute acceptance of the Cardholder Agreement that will be provided to you with your Card(s), which is governed by both Utah law and applicable Federal law.
Summary of Terms