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cIrIBAN(@



5424
54-2-D sy
SINCE9

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" NO FEE

SPECIAL STUDENT RATE

'TRAVEL DISCOUNTS

®PHOTOCARD

PLAETELL US ABOUT YOURSELF

I Prin Ful Nine, First. Middle Intial, Last
Your Per rinunt or Parents Home Address
Your Permanent Area Code and Phone Number


Social Security Number

Date of Birth (Month/Day/Year) Motrher's Maiden Name





Apt. No. City orTown
First ano Last Name under which your permanent phone is listen with Directory Assistance

State Zip



PLEASE TELL US ABOUT YOUR SCHOOL
Full Nawn of College/University (Please Do Not Abruvate) Branch/Campus Official School Zip
Your Ma ing Addiess at School I different from Permanent Address) Apt. No, City or Tomn State Zip
tocir Are-i Code .ind Prone Number at School Frst and Lust Nanme unen mhich your school phone us isneed with Directory Annismourn
Your Class: Q Fresh (A) D Junior (j) D Crud Stuont (G) Perma-nent U. S. Reen Addrens to Fhich you mant your card and hilling statement wailed
Q Soon (B) D Senior(S) DYes D No D Permanent D School
OTHER IMPORTANT INFORMATION


I Moiney MaktInvestment Account? D Yes D No
R.. , Name.
Chtecing Accoutf DYes Q No
honk Nave.
Savings AccountnC~s/lrnanury P1ls f DYes C No
hg ii. Namre

J u do non have to include spouse's incomealiwotychild support ornseparate maintenance paywents paid if you
ame not relying on them to estahish cweditworthiness. Financial ai dane tudiot arn not applicahle an sources of income.
Annual Source(s): El Full-time (oh ElSummer job ID Savings
Income* _P 0 Part-time (oh QC Allowance DI Stipend

Name of Employer (Most Recent)
Employer Area Code and Phone Number


VERIFICATION OF SCHOOL ENROLLMENT
Please include a legible copy of one of the following: Your application cannot be processed without this information and wili besubstlaly
delayed if you omit any informtion requested.(Be sure the copy shows your name,
D The front and hack of your VALIDATED Student ID for current semester. Q PAID tuition bill for current semester the date and your current enrollment statusPhotocopy both sdesfnecesary)
PLEASE SIGN HERE

Icertify mhat I meet and agree no all Citibath credit terms and conditions of offer on the other side. Please allow 30 days to process this application.
Applicants Signature

Dane


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