PLEASE COMPLETE, DETACH, MOISTEN, SEAL AND MAIL (NO POSTAGE IS NECESSARY).

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
First Middle Initial Last
1. Social Security # Date of Birth
Month/Doy/Year
2. Permanent Home Address
Street
City State ZIP
( I
Permanent Home Phone
3. Residency Status Q U.S. Citizen Q Permanent Resident J Other
4. Mother's Maiden Name
(A confidential feature to verify ardholder's identification)

Your Choice - choose only one.

Q Burton Memorial Tower
EY-576

Q Michigan Stadium
EY-575

Key Code
si

8. Source of Personal Income: (Check 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 Persennl lnrnme

j Financial Aid Q Part-time Job Q Full-time Job
Q Other

Emolover (If arylicable)

Q Current
Q Future
Q Summer

5.
6.
7.

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

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

Q Visa®
Q MBNA®

10. Name of Parent or Closest Relative

Class: Q Freshman Q Graduate Student
Q Sophomore Q Continuing Education
Q Junior Q Law School

Q Full Time
Q Part Time

E-HC
891

Street
City State ZIP
Relationship
t hose read this applicatioa and everything t hose stated is true. MONA America tank, N.A. is aothorized to check my credit, employment
history, or any other inormation and toreprt to others such information and credit experience with me. I understand that the acceptance
or use oany card issued will be subiect to the terms of this application and the Credit Card Agreement that will be sent with the card, and I
sgree to be responsible for all charges incurred according to such terms. For faster processig of your application, include a photocopy of
your current student ID or a copy at your transcript to verify enrollment.

Q Senior

Q Graduate Business School

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

Applicant's Signature

Date

SEE REVERSE SIDE FOR DISCLOSURES. S295