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* Great Benefits * No Annual Fee * 15.4% APR,
Apply Now! It takes only 2 minutes-and no co-signer.
1 YES! I want my Citibank Classic Card Select One: Q Citibank Classic MasterCard, J Citibank Classic Visa
To speed processing of your application, please complete all sections below. Write N/A for any items that do not apply to you.

12/93

Please tell us about yourself

2 Pint Full Name - First, Middle Initial, Last

Social Security Number

Your Date of Birth (MonthiDay/Year) Mother's Maiden Name


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Your Permanent Home Address Apt. No. City or Town State Zip
Your Permanent Area Code and Phone Number First and Last name under which permanent phone is listed with Directory Assistance
Please tell us about your college/university

3 Full Name of College/University (Please do not abbreviate) Branch/Campus Official School Zip
Your Mailing Address at School (if different from Permanent Address) Apt. No. City or Town State Your Zip
Your Area Code and Phone Number at School First and Last name under which school phone is listed with Directory Assistance
( ) -
Your Class i Fresh J Junior J Grad JOther Expected Graduation Date Permanent U.S. Resident Address to which you want your card and billing statement mailed
JiSoph JiSenior LiFaculty/Staff (Mo) (Yr) JYes INo J Permanent J School

Do you have:
A Money Market / Interest-Bearing Checking/ NOW Account J Yes l No
Bank Name:


Checking Account JYes J No
Bank Name:
Savings Account/CDs/Treasury Bills JiYes JNo
Bank Name:

Important information
Vaennae to include spoosen income, alimony, child support or separate maintenance
payments paid to you if you are not relying on them to establish creditworthiness. Financial aid
and tuition are not applicable as sources of income.
Annual Source(s): LFull-time Job L Summer Job L Savings
Income $ JPart-time Job JiAllowance J Stipend
Employer (Present, Future or Previous/Summer)
Employer Area Code
and Phone Number \

6 Please include a legible copy of one of the following: Your application cannot be processed without this information and will be substantially delayed if you
0 VALIDATED Student ID for current semester El Tuition bill for current semester omi nformatop b ( s u te c y shows your name, the date and your current enrnsa-
Please sign this authorization

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I certifiy that I meet and agree to all the Citibank x
credit terms and conditions of offer on the other side. _ __
Please allow 30 days to process this application. Applicant's Signature



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Date



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CB-0016A (12/93)