LE~V1 SELECT ONE El CITIBAN(@ Y;EQ CITIBAN(@ M To speed processing of your application, please complete all sections below. Write N/A for sny items thst do not apply to you. PLESE ELLU . UIOREF I I Prit fllnamkFratMad Ainiia/Llt o ianl S AcaritynNumber Pemn(J hoNme a n Ara od Nmeunerwhchphneisisue wthDiecor Asitac Da oyBiprth NaymeiofpSchool (Please dgoannot abbbreviate) Branchs YoW oNuen AeaCoeandcholmamaudedwhchphneisissedwih irctoy ssstnc Yulas QFrsAQLuiorTE GtudentI O thO r GIraduition billPfor a ioytUfoesdoo nun(nt drsuatohicyousntyouardadblln th atemn a ldu orcurreSems rent semesteraf ' I I Q esQ on QnnlPnermtatsaPheoopykunQidnSchnoolay~ ----------- , ,I c/rIBAN(EO exchangeinormtin aoutuhowuIandle my accounwinhprper perons andwinhacredibureausnifIamnissuedauard. lauthorize my employer, my bank, and any othenreferences listnd above tu neleane and/oanverify innonmanion to Citubank (South Dakota), NdA and ins affilanes in onderntadetnrminenmy eligdiiniy fun nun Cutbankcnndit card. Iam awann that infonmaion gtnurnd abounan insuned ta determinenmynelgibilty forntheacrdit ard acounn and anynnnnewalo unnurnnnxnnnsioun rditn IfuIask,lIuwllubentldaunnue rnn ot consumen repnrs un me wnrn rnqunstnd and nun names anfnuneanneditbunnaun, wann nuniraddrnsses,tnan prouided tnunrpunks. If I dnsgnaean anthurnzednusnnto ueynad, Iundnrstandnuanataontnninnomatnwill alsobenneporedntonndinkbunan the antuoniaed usnnssuamn IacerifyluhanlIamn18ynansofanganoroldn, andnuhath nn oan on pnonaidediauan.lIundestandtanf I usennunandnnraunthorintsusenordonotnancnl my accoun ihin 30daysnaftnnlnnrceuive heardtunCituankAgnnnmnntunentnno mewithuthenard willubeuindin nnme. WISCONuIN RESIDENTS ONLY: Wisconsin lam pnnuidnsatana nnoamntncanna onden on individual snannmnnn applyngtounmanital propenty mill afnfnca anrdnton'snitenenns unless yuain nunhelion cnedit in gnanted, nun cnedinornia funnisued with a anpy ofnun agnnemnent, curunonder, onusatemntn,nnruasactual knoldgenfuneadvnnspnvisin. Inn dnnrntnnbec nrd fornaCitikanknMastnnCandnnr CnuiankuVsancand youmusnncomplenenandsinuis appliation.Omissnunfnanyuofithnnnfonmatiionnnequnsfndinnthisapplicationmay bn gnounds Inn dnnial. Plnase aloas30 days tn pnoness younapplination. Detach and mail this coupon to: CITIBANK (SOUTH DAKOTA), N.A. CITICORP CREDIT SERVICES, INC. (MD) ONE CITICORP DRIVE HAGERSTOWN, MARYLAND 21749 /065 15 C , ' E tt ht - , Applicant's Signature X _ Aplians igatreXDate _____MCV999'1-12as 9/88