A credit service of GE Money Bank

183-859-00

Rev. 6/08/09

DATE OF PRINTING 6/09

For WI residents, if you are applying for individual credit or joint credit with someone who is not

your spouse, combine your and your spouse's financial information on the application form.

PLEASE READ AND KEEP THE GE MONEY BANK KEY CREDIT TERMS

AND INITIAL CARDHOLDER DISCLOSURE STATEMENT BEFORE SIGNING THIS APPLICATION.

I am providing the information in this application to GE Money Bank (“GEMB”), to GE Money credit card, to dealers (“Dealers”) that accept the GE Money credit card (“Card”) and to program

sponsors, and asking GEMB to issue me a Card. By applying for this account, I authorize and agree that:

· GEMB may furnish this and other information about me (even if my application is denied) and my account to GE Money credit card and to Dealers and program sponsors (and their

respective affiliates) to create and update their records, and to provide me with service and special offers.

· GEMB may make inquiries it considers necessary (including requesting reports from consumer reporting agencies and other sources) in evaluating my application, and for purposes of

reviewing, maintaining or collecting my account.

· If my application is approved, the GE Money credit card Agreement (“Agreement”) will be sent to me and will govern my account.

purchased on the account as permitted by law.

· I consent to GEMB and any other owner or servicer of my account contacting me about my account, including using any contact information or cell phone numbers I provide (whether

now or in the future) , and I consent to the use of any automatic telephone dialing system and/or an artificial or prerecorded voice when contacting me, even if I am charged for the

call under my phone plan.

· This application and the Agreement are governed by federal law and Utah law (to the extent that state law applies).

Signature of Applicant Signature of Co-Applicant (If Applicable)

(Please Do Not Print) Date (Please Do Not Print) Date

RETAILER # ACCOUNT # KEY # AMOUNT OF INITIAL

TRANSACTION

APPLICANT 1st ID TYPE/NUMBER ISSUANCE STATE EXP. DATE APPLICANT 2nd ID (CREDIT CARD TYPE & ISSUER) EXP. DATE

#___________________________________________________________________________

CO-APPLICANT 1st ID TYPE/NUMBER ISSUANCE STATE EXP. DATE CO-APPLICANT 2nd ID (CREDIT CARD TYPE & ISSUER) EXP. DATE

#___________________________________________________________________________

RETAILER PHONE # RETAILER FAX #

VERIFIED BY:

APPLICANT SIGNATURE MATCH APPLICANT PHOTO MATCH

Name (First-Middle-Last) Please Print Date of Birth Social Security No. Home Phone No.

/ / - - ( )

Mailing Address* Apt.# City State Zip Time at Address Cell / Other Phone Where We May Call You

Yrs. ____ Mos. ____ ( )

Contact Person Name Street Address (Street Name and Number) City State Zip

Housing Information Monthly Net Income From All Sources Time At Job Employer's Phone No. Relative Phone No.

$ __________________________ Yrs. ______ Mos. ______ ( ) - ( ) -

Alimony, child support or separate

maintenance income need not be

disclosed unless relied upon for

credit.

E-Mail Address (optional) By providing an E-mail address, I consent to receive E-mail communications about my Account and authorize you

to provide my E-mail address to the Retailer/Dealer/Merchant where I applied and the Retailer/Dealer/Merchant

where my credit card is honored so that I may receive such communications, offers and updates.

Name (First-Middle-Last) Please Print Date of Birth Social Security No. Home Phone No.

/ / - - ( )

Mailing Address * Apt.# City State Zip Cell / Other Phone Where We May Call You

( )

Contact Person Name Street Address (Street Name and Number) City State Zip

Housing Information Monthly Net Income From All Sources Employer's Phone No.

$ __________________________ ( ) -

Alimony, child support or separate maintenance income

E-Mail Address (optional) By providing an E-mail address, I consent to receive E-mail communications about my Account and authorize you to

provide my E-mail address to the Retailer/Dealer/Merchant where I applied and the Retailer/Dealer/Merchant where

my credit card is honored so that I may receive such communications, offers and updates.