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PLEASE TELL US ABOUT YOURSELF
First Name MI
Last Name
Address
City State Zip
 
E-mail Address
Mother's Maiden Name
Previous Address (if less than 2 years at current address)
Address
City State Zip
 
Birth Date Social Security Number
Home Phone Business Phone
Your Employer How Long
Position
Annual Income From All Sources $
*Alimony, Child Support or separate mantenance income need mot be disclosed unless relied upon for credit
# of Dependents Do you (check one)
Own Rent Live With Parents
How Long Have You Been Living At Your Residence
 
Mortgage / Rent Payment $
Credit References (Check all that apply)
Checking
Savings
Visa
MasterCard
 Sears / Discover
AMEX / Optima
Dept. Store
None

If your Credit Reference can be verified in any other name list that name here
Driver's License Number State
Driver's License Expiration Date
Closest Relative Not Living With You
Closest Relative's Phone Number
PLEASE COMPLETE FOR JOINT APPLICATION
First Name MI
Last Name
Address
City State Zip
Social Security Number Relationship to Applicant
Spouse Other
Annual Income From All Sources $
*Alimony, Child Support or separate mantenance income need mot be disclosed unless relied upon for credit

CREDIT CARD AGREMENT("AGREEMENT") ACKNOWLEDGEMENT
Applicant(s) ("you") request a credit card(s). You represent that the information supplied in this Application is complete and accurate and that your Account will be used only for personal, family or household purposes. You authorize Mongram Credit Card Bank of Georgia, Atlanta, GA ("We", "us" or "our") to make whatever inquiries we consider necessary and appropriate concerning this information. You give us permission to request consumer reports from consumer reporting agencies in considering this Application and subsequently for the purpose of any update, renewal or extension of credit, or reviewing or collecting the Account. Upon you request, we will inform you of the name and address of each consumer reporting agency from which we obtained a consumer report relating to you. Service (finance) charges at rates not in excess o those permitted by law will be charged on outstanding balances from month to month. You agree that the attached Agreement provides for the compounding of finance charges.
NOTICE TO APPLICANT(S): (A) DON NOT SIGN BELOW BEFORE YOU READ THE ATTACHED AGREEMENT OR IF THE AGREEMENT CONTAINS ANY BLANK SPACES. (B) YOU ARE ENTITLED TO A COMPLETELY FILLED IN COPY OF THE AGREEMENT. KEEP A COPY OF THE AGREEMENT TO PROTECT YOUR LEGAL RIGHTS. (C) YOU MAY AT ANY TIME PAY OFF THE FULL UNPAID BALANCE UNDER THE AGREEMENT WITHOUT INCURRING ANY ADDITIONAL CHARGE. (D) YOU MAY UNDER CERTAIN CIRCUMSTANCES REDEEM THE PROPERTY, IF REPOSSESSED BECAUSE OF YOUR DEFAULT, AND YOU MAY, UNDER CERTAIN CONDITIONS REQUIRE A RESALE OF THE PROPERTY REPOSSESSED. (E) THE SELLER HAS NO RIGHT TO UNLAWFULLY ENTER YOUR PREMISES OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT (F) IN MASSACHUSETTS AND WASHINGTON: YOU MAY CANCEL A PURCHASE UNDER THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO AT A PLACE OTHER THAT THE ADDRESS OF THE SELLER WHICH MAY BE HIS MAIN OFFICE OR A BRANCH THEREOF; PROVIDED YOU NOTIFY THE SELLER IN WRITING AT HIS MAIN OFFICE OR BRANCH, BY ORDINARY MAIL POSTED, BY TELEGRAM SENT OR BY DELIVERY, NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING A PURCHASE UNDER THIS AGREEMENT.


You agree to be bound by the terms of the attached GECAF Credit Card Agreement (WHICH INCLUDED AN ARBITRATION PROVISION WHICH MAY SUBSTANTIALLY LIMIT YOUR RIGHTS), which is incorporated by reference in and made a part of this Application. You also agree that there is no agreement between you and us until we approve you Application and accept the Agreement at our office in Georgia. The Agreement will, if accepted by us, be treated a s made in Georgia. Cards are issued and credit is extended by Monogram Credit Card Bank of Georgia, Atlanta, GA.