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CREDIT APPLICATION

APPLICANT'S INFORMATION

Name (First, Middle, Last):

EMAIL:

SOCIAL SECURITY NUMBER:

DATE OF BIRTH (MM/DD/YYYY):

STREET ADDRESS (NO PO BOX):

CITY:

STATE:

ZIP CODE:

APPLICANT
RENTS OWNS

MONTHLY RENT OR MORTGAGE PAYMENT:

HOME VALUE (IF OWNS OR BUYING):

MORTGAGE BALANCE (IF OWNS OR BUYING):

AT CURRENT ADDRESS
YEARS:MONTHS:

HOME PHONE:

MAILING ADDRESS:

CITY:

STATE:

ZIP:

EMPLOYER:

POSITION:

HOW LONG?
YEARS:MONTHS:

WORK PHONE:

YEARLY SALARY:

OTHER INCOME:
Income from alimony, child support, or separate maintenance payments need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation.

CO-APPLICANT'S INFORMATION
I(IF YOU ARE APPLYING FOR JOINT CREDIT)

Name (First, Middle, Last):

EMAIL:

SOCIAL SECURITY NUMBER:

DATE OF BIRTH (MM/DD/YYYY):

STREET ADDRESS (NO PO BOX):

CITY:

STATE:

ZIP CODE:

HOME PHONE:

MAILING ADDRESS:

CITY:

STATE:

ZIP:

EMPLOYER:

POSITION:

HOW LONG?
YEARS:MONTHS:

WORK PHONE:

YEARLY SALARY:

By clicking on the SUBMIT button I acknowledge I have read the NOTICES TO APPLICANT AND CO-APPLICANT below and willingly comply with the information and requirements contained therein.

NOTICES TO APPLICANT AND CO-APPLICANT

1. This application will be submitted for consideration to CitiFinancial Retail Services Divsion of Citicorp Trust Bank, fsb, a federal savings bank (the "Bank"), whose mailing address is PO Box 22060, Tempe, AZ 85285-2060.

2. You authorize the Bank to gather information about you it considers necessary or desirable (including obtaining your consumer report from consumer reporting agencies and gathering information from employers, your banks and other sources) in evaluating this application, and if this application is approved, thereafter for purposes of updates, renewals, extensions of credit, reviews and collection of your Account. If you ask the Bank, the Bank will tell you whether or not the Bank requested a consumer report for you and the names and addresses of any consumer repoarting agencies that provided it such reports.

3. If this application is not approved by the Bank, you authorize the Bank and the merchant to furnish all of your application information to other possible financing sources for credit programs such other sources may offer, and you authorize such other sources to make inquires about you they consider necessary or desirable (including obtaining your consumer repoart from consumer reporting agencies) in evaluating you for credit.

4. If this application is approved by the Bank, you agree to all of the terms and conditions of the attached agreement (Form 25592-BB PLCC Application/Agreement 23.99% (09/06)) (the "Agreement"), which are incorporated herein by reference.

5. Do not sign this application before you read the agreement. You acknowledge receipt of the Agreement before making any purchases under the Agreement.

6. Paragraph 22 of the Agreement provides that you grant the Bank a security interest in goods for certain purchases made with your account.

7. Paragraph 27 of the Agreement contains provision requiring arbitration of various claim and controversies.

8. Any married person may apply for a separate account.

9. If this application is signed by the Applicant and Co-Applicant, you acknowledge that you are applying to the Bank for joint credit and that if this application is aproved by the Bank, each of you will be liable under the Agreement for all credit extended under the Agreement to either or both of you.

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