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September 12, 1988 - Image 25

Resource type:
The Michigan Daily, 1988-09-12

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Select One: QI Citibank MasterCard® or oI Citibank Visa®
Please use ballpoint pen.

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Prit ul ame Frst Midle IitalP Last ameofS chol I ( Brnc
appear n ad Yur AddessatSchool
ScrtNu rI I (I ' I l' II 'Bit I I I I if dffren fop ermannt adress)I p I I IPp I L
Pem an n I ( ' I I I I I' ( ( I I I I I rP , fic I I I I I I I ( 1 11I I dp tillo
PemnetPhn f ( I I INm ha
and Area Code AppearsDpppponpPhone]pBill
NpaeTat phpp~ I II I I I I (I iI I I I Your dFreshman Q Sophoor QJuor Q Senior
Ap5pars onPhon Bll lasPsGadat Sudnt ElFauly/taf Ohe
U..Ctzn l Ys IfuNo, Are YuupQ []Yes0
No- APPermanent Resident? Q No " INFORMATIPOyPp~PPPPPPPOPdPPdaaY
(Joint or Indiidual) I: 17TI7.-1"1771
CheckingppAccount ppNumberpBank Nme y5sinin belwIauthorizeCitibank (South DakotPa), N.A to checkPmy crdit hstor an excang
(Joint orIndividual)PifomaionPabouthow I handlePPmypaccount pp withPproe erosad ihcrdtbreu fIam isud a
_____________________________________________card._____ Ip ~autoie yployer~P, Py bank. and any other references listedaov t rlasead/or veify
(Joint orIndividual) the crdit card acout a dy rene al orpfutre exten ionofcrdit II ask. IwillIbetodpwhthr o no
cosuerrprt onme erereuetad the nPP p P p pame ftecrdtbr a, wih teiraPddresss, a t P
Annual Q Soucus:alalLAlloanceSa vinpgs QLSummerJob providedth p orts.f Ip ermitPPmyPspuse to use my ard, I uderstandthat accountinform aiwilalso
Income $ Q SaarySipend be reported to crdit buraus in myspouse' nam . I certiy thatI am 18Pyars of age.orPolderand that the
Name fEploye (Present. my account within PPdapys PPP paftr Prceveth pardthe Citibanpk AgreementPSentPp me with Phepard il
EmployerapTlephoe( II I I In ordr tbe cPoidefo alCtiba~kMasteCad or aitibaksPard you must co~plete ad
and AraaCodea Jasgn hsioapplication.aOmissiaioofayaofthiforaion reqestd inhi appliation maybegrounds
____________________________________________for denial.Iaverify that PhaveO read auderstadhedisosure boxappon ebackPlease do notsend
PYou pneed pnot inclde spouse's incomeP, aimony, pchpid asuppPrt Pp separateaintna ncepaPPPpayments~ paid payment of$20 annalfee; you will beabilledlater.
p~pppd~lppo~pp~yigPPp~PP~~aaab~PPad~PPPl~a.Taenuretat uyour appicuatinsprocPsseadaunquickly aspossaiblP, pleuse completeall
the inforinre quasted and mail to Citibank (Soath Dakota) N.A., Citicorp Credit
Services, lnc. (MD), One Citicorp Drive, Hagerstown, Marylaand 21748-0002.
EC9421-12 X

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