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This collection, digitized in collaboration with the Michigan Daily and the Board for Student Publications, contains materials that are protected by copyright law. Access to these materials is provided for non-profit educational and research purposes. If you use an item from this collection, it is your responsibility to consider the work's copyright status and obtain any required permission.

September 08, 1995 - Image 27

Resource type:
Text
Publication:
The Michigan Daily, 1995-09-08

Disclaimer: Computer generated plain text may have errors. Read more about this.

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MOISTEN HERE

PLEASE TELL US ABOUT YOURSELF

SC6742 ID

d i i l

Last Name

First Name
FirstNameMi dle m nta
Social Security Number Date of Birth (Month/Day/Year) Mother's Maiden Name
Your Address at School Apt. No.
City State Zip
Current Phone
Your Permanent Home Address Apt. No.
City State Zip
Permanent Home Phone Card/Billing Statements
Should Be Sent To: (Check one only) Q School Address Q Permanent Home
PLEASE TELL US ABOUT YOUR EDUCATION
Your School Name
Class Level: E h Graduation Date (Month/Year) GPA
DFreshman l Sophomore EDiJnior LI Senior l Graduate
VERIFICATION OF SCHOOL ENROLLMENT
Please include a legible copy of one of the following: Your application cannot be processed without this information and wilt automatically be
Q The front and back of your VALIDATED Student ID for current semester delayed if you omit any information requested. (Be sure the copy shows your name, the date
PAID tuition bill for current semester and your current status. Photocopy both sides if necessary.)
PLEASE PROVIDE SOME FINANCIAL INFORMATION
Please check if you have: Q Checking Account Q Savings Account
BALANCE TRANSFER OPTION
Transfer the amount shown from the MasterCard , Visa*, Discover* or Optima" account listed below to my new Visa' account
Amount (indicate in dollars) Account Number
$ (refer to credit card) DlEE DL DEIE1 EEIL EZI
X
Your Signature Date
Authorization: I certify that I am at least 18 years of age, and that I have read and agreed to all of the terms, conditions and disclosures contained on the reverse side of this form, and that I have accurately and fully completed all items on
this application. I understand that my new credit card account will be with First USA Bank, located in Wilmington, Delaware. I authorize First USA Bank to check my credit and employment history and to report to others its credit expenience
with me. I understand that the use of any card in connection with this application wil be subject to the terms and conditions of the First USA Cardmember Agreement that will be sent with the card. I agree to be responsible for all charges
incurred according to the Cardmember Agreement. I understand that the terms of my account are subject to change as provided in the Cardmember Agreement.
MOISTEN HERE

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