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  • Columbus Ohio: 614-334-3472
  • Akron Ohio: 440-926-6590
  • Cambridge Ohio: 740-521-4587
  • Cincinnati Ohio: 513-360-4217

  • Cleveland Ohio: 216-539-2456
  • Dayton Ohio: 937-353-7027
  • Toledo Ohio: 419-679-4216
  • Youngstown Ohio: 330-752-2073

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APPLICATION AND CREDIT CARD ACCOUNT AGREEMENT
Credit is extended by GE Capital Retail Bank
**MARRIED WI Residents only: If you are applying for an individual account and your spouse also is a WI resident, combine your and your spouse's financial information.
1. APPLICANT INFORMATION: Please tell us about yourself. Please note that you must reside in the United States and be 18 years or older to apply.
Name (First-Middle-Last) Date of Birth Social Security Number Primary Phone *
 /   /  - - - -
Mailing Address Apt. Number City State Zip Code Cell/Other Phone Number *
- -
If the above address is a P.O. Box, you must provide a street address for yourself or a contact person.  
Contact Person Name Street Address (Street Name and Number) City State ZIP
Housing Alimony, child support or separate maintenance
income need not be included unless relied upon for credit.
You may include the monthly amount that you have
available to spend from your assets.**
Monthly Net ncome
From All Sources
Employer's Phone Number * Relative's Phone Number*
$ - - - -
E-Mail Address *

* You authorize GE Capital Retail Bank (“GECRB”) to contact you at each phone number you have provided. By providing a cell phone number and/or email address, you agree to receive special offers, updates and account information, including text messages from GECRB and the dealers/merchants/retailers that accept the Card. Standard text messaging rates may apply.

2. JOINT APPLICANT INFORMATION: An additional card will be issued to the person indicated below. The applicant (and joint applicant, if any) will be liable for all transactions made on the account including those made by any authorized user. JOINT APPLICANT: You agree that we may send notices to you and/or applicant at the applicant's address, regardless of whether you live at that address.

Name (First-Middle-Last) Date of Birth Social Security Number Primary Phone *
 /   /  - - - -
Mailing Address Apt. Number City State Zip Code Cell/Other Phone Number *
- -
If the above address is a P.O. Box, you must provide a street address for yourself or a contact person. 
Contact Person Name Street Address (Street Name and Number) City State ZIP
Housing Alimony, child support or separate maintenance
income need not be included unless relied upon for credit.
You may include the monthly amount that you have
available to spend from your assets.**
Monthly Net Income
From All Sources
Employer's Phone Number * Relative's Phone Number*
$ - - - -
E-Mail Address *