* Mosten andSeal
Low Monthly Payments $1000 Credit Line**

4

Address where yes west card and billing statement mailed:
Name Yor MalngAddressoathScho(

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Apt. No.T Ciy/State/Zip
STUDENT INFORMATION
PermatentOAdress (iffertet fttom School) City State Zip
School Telephone Home Telephone College Name City Stote
Class: Z]taO. Studett D Setior Gadotion Sate Sociol Secotity Numbet Date of Birth Ate you aSUS. Citiet? I10No. gioeVisaoStatus
uZio 7O ithertE Yes LINo
SEMPLOYMENT/FINANCIAL INFORMATION
Name ofEmployer Telephote
EmployrtAddtess City State Zip
Name oBank City AccounttNumber
Petsontal Reetencel(Neatest Relaiveat ditterent addreos)Addtess
City State Zip ITelephote
SJOINT ACCOUNT INFORMATION (OPTIONAL)
Complete this section if you are applying for aJoint Account, or if you are relying on the income of another person to
qualify for the account, or if you area married Wisconsin Resident. IMPORTANT: Joint Applicant must sign below.
:] pouse Name Social Secutity Numbet Dateo irth
D Othet
Addtesso(iftdttetenttftomyouradtress) Cty State Zip
Empoyet Name Addtess City State
SSIGNATURE(S) REQUIRED
I authorize tGreenwood Trust Company to check my credit record and to verify my ctedit, employment sod income teferences. t hose toad the
Impodtant Infonmation on the reverse side. I aoree to those teems and to the account teems and charges specified in the Discoven Cardmember
Agreement which I understand may be amended in the future, unless I return my cardis) within 30 days of receipt.
X X
Applicats ignature sate Joint ApplicattoSignature sate
I understand that Greenwood Trust Company may amend the account terms and charges specified in the Discoser
Cardmember Agreement in the future. 1/92
C 192 Greenwoaodrut Company, memer eFDIC 'There is a $t5 annual fee in North Carolina and Wisconsin.
**Up to $t555 credit line if you quality.