THE APPLICATION INSTRUCTIONS:
To assure timely processing, completely fill out all spaces and sign
the application before mailing. The application is to be completed in name
of person in which the account is to be carried. Please attach a
photocopy of your student ID or paid tuition bill for the current semester.

0
4,

ADDRESS where you want card and billing statement mailed:
First, Middle, Last Name (leave space between each) FSM I
Billing Address Apt. No. City State Zip
STUDENT info:
Your Telephone Number At School Permanent Home Telephone Social Security Number Birth Date (mo. day yr.)
Home Or School Address (different from above-required) Apt. No. City State Zip
College Name (no abbreviations, please) City State Zip
Are You A U.S. Citizen? Are You A Permanent Class: 71 Grad Student I Senior CI Junior Graduation Date (mo. yr.)
(if no, give immigration status) U.S. Resident?
o Yes EL No O Yes 0 No E Freshman n Sophomore
Employment INFO:
Name Of Employer (If currently employed) How Long Yearly Gross Income Employer's Telephone
( )
Employer's Address City State Zip
Financlal/ SECURITY info:
Mother's Maiden Name (for security purposes) Do You Have:
O Checking Account E Savings Account
Signature required:
I authorize Greenwood Trust Company to check my credit record and to verify my credit, employment and income references. I have read and agree to the Important
Information on the back. I agree that if I use my Card or Account I will be subject to the terms and charges specified in the Discover Cardmember Agreement which will
be sent with my Card. I certify that I am age 18 or older and that the information provided is accurate. I understand that the information contained in this application
may be shared with Greenwood Trust Company's corporate affiliates. I hivv attched . PHiOTOCOPY o- my st)et D cr paid tuition bill for the
current semester.

X

Applicant's Signature

Date


Here's where you LICK it, seal it and MAIL it. Postage is FREE.