Low Monthly Payments $1000 Credit Linre**
E32N
Address where you want card and billing statement mailed:
NatteYourtMaing Address at School
Apt. No.Cty/StatetS p
STUDENT INFORMATION
PermanetAddresso(If Different from Sctool) City State Zip
SchtolTeteptone Hotoe Teephote Coltege Naote City State
Claso QStat. StudentQSeniot Gadaaton Date Socal Secuity Numbet DateoBtt Ate youatU.S. Ctzet? IfNogive VsaStatus
Juniot Q ttet toeso QNo
SEMPLOYMENT/FINANCIAL INFORMATION
Natetof Empoyerreleptote
EmployetAddress City State Stp
Nameo atk City AccounttNumber
Petsootal efeeeeNeateot Retiteat ditetenttaddtess) Address
City State Zty Teteptote
10 JOINT ACCOUNT INFORMATION (OPTIONAL)
Complete this section if you are applying for aJoiot Account, 0r if you are relying on the tncome of another persoo to
qualify forthe accmunt, or if you are a marrted Wisconsin Resident. IMPORTANT: JointApplicant most sign below.
Sp oe Name SociatSecurity Number Date ofBittt
QOttor
Addtess (idifetenttfrom youroaddtess) City State Siy
EmployertName Address City State
00 SIGNATURE(S) REQUIRED
I authorize Greeowood rust Compaoy to check my credit record aod to oerity my credtt, employmeot aod tncome references. I haoe toad the
Important Informatton on the reoerso side. I agree to those teems and to the account tetms and charges spocified to the Dtscooet Cardmembet
Agreement whtch I understand may So amended in the future, unless I tetur my cardls) within 30 days ot teceitt
X X
ApyyicanttsStgtatute uate Joti~nt pliants itatute Date
I understand that Greenwood Trust Company may amend the account terms and charges specified to the Dtscooer
Cardmember Agreement in the future. 1/92
1992Grenood ust Ctompany, mombot~itS There to a $15 annual tee to North Caroltna and Wtsconstn.
"Up to $1ooo creditlitne iy you quality.