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FILL IN THE BLANKS
OR CALL TOLL-FREE
1-800-847-7378
(TDD users, call 1-800-TDD-MBNA)

JOIN THE GROWING NUMBER
OF U OF M STUDENTS
ALREADY CARRYING THESE
SPECIAL DESIGNER
VISA CARDS.

Name as you would like it to appear on card
I I I I I I I I I I I I I I I
First Middle Initial Last
1. Social Security # Date of Birth
Month/Day/Year
2. Permanent Home Address
Street
City State ZIP
( )
Permanent Home Phone
3. Residency Status J U.S. Citizen Q Permanent Resident Q Other
4. Mother's Maiden Name
(A confidential feature to verify cardholder's identificotion)

Your Choice - choose only one.
Q Burton Memorial Tower EJ Michigan Stadium
EY-576 EY-575

Key Code
ST

8. Source of Personal Income: ((heck ALL that apply. Alimony, child support or separate maintenance income need not be
revealed if you do not wish it to be considered as a basis for repayment.)

Q Parents
Q Scholarship/Grant
Total Personal Income S
Emolover (If aoolicable)

Q Financial Aid Q Part-time Job Q Full-time Job
Q Other
Q Current
Q Future
Q Summer

5.
6.
7.

Campus Phone ( )
Residence: ] Live in dorm Q Live with parents Q Rent Q Own
School
Campus
Major Field of Study

9. Other Credit Card Accounts: Q MasterCard®
2 American Express®

Q Visa®
Q MBNA®

10. Name of Parent or Closest Relative
Street
City State ZIP
Relationship
I hove read thiv application and everything I hove stated iv true. MBNA America tank, N.A. iv authorized to check my credit, employment
history, or any other information an to report to others such information and credit experience with me. I understand that the acceptance
or use of any card issued will be subject to the terms of this application and the Credit Card Agreement that will be sent with the card, and I
agree to be responsible for all charges incurred according to such terms. For faster processing of your application, include a photocopy of
your current student ID or a copy of your transcript to verify enrollment.

Class: Q Freshman A Graduate Student
2 Sophomore 2 Continuing Education

Q Full Time
Q Part Time

E-HC
B91

Q Junior
Q Senior

2 Law School
I Graduate Business School

U

Year of Graduation 2 1995 Q 1996 Q 1997 Q 1998 Q 1999

Applicant's Signature

Date

5295

SEE REVERSE SIDE FOR DISCLOSURES.