Application Form For A Wal Mart Discover Or Wal Mart Credit Card

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Application for a Wal-Mart
®
Discover
®
or Wal-Mart
®
Credit Card
Complete and mail to: GE Money Bank
PO Box 981419
El Paso, TX 79998
1. Applicant: Please tell us about yourself.
First Name
Initial
Last Name
Date of Birth (MM/DD/YYYY)
Home Address (Street Name and Number Required)
City
State
Zip
❑ Own
❑ Rent
Previous Street Address (If Less Than One Year At Present Address)
City
State
Zip
Home Phone
Business Phone
Cell / Other Phone Where We May Call You
(
)
-
(
)
-
(
)
-
Annual Income from all Sources*
Mother’s Maiden Name
Social Security Number
-
-
$_________.00
By providing my E-mail address, I consent to receive E-mail
E-Mail Address (Optional)
communications about my Account and authorize you to
provide my E-mail address to Wal-Mart and
so I can receive special offers and updates.
*Alimony, child support or separate maintenance income need not be disclosed unless relied upon for credit.
WI RESIDENTS: If you are applying for an Individual Account, combine your and your spouse’s financial information in Section 1 above.
GE Money Bank will first consider you for a Wal-Mart
Discover
. If you do not qualify for a Wal-Mart
Discover
, you will be
®
®
®
®
considered for a Wal-Mart
®
Credit Card. Consider me for the Wal-Mart Credit Card only.
2. Authorized User:
An additional card will be issued to the person indicated below. The primary cardholder will be liable for all
purchases made on the account, including those made by any Authorized User.
First Name
Initial
Last Name
❑ Spouse
❑ Other
3. Please Choose Your Payment Due Date:
Check One
.
❑ No Preference
❑ Middle of the Month
❑ End of the Month
❑ Beginning of the Month
4. Applicant: we need your signature below.
By signing this application, I ask that GE Money Bank (“you”) issue me a Wal-Mart
®
Discover
®
or Wal-Mart Credit Card. I understand that
if I qualify for a Wal-Mart
®
Discover
®
or Wal-Mart Credit Card, you will assign me an Annual Percentage Rate depending on my
creditworthiness as determined by you. I am providing this information both to you and to Wal-Mart Stores, Inc. I also authorize and direct
you to furnish information about me (including whether this application is approved or declined) and, if it is approved, information about
my Account, to Wal-Mart Stores, Inc. (and its affiliates) for use in connection with the Wal-Mart
®
Discover
®
or Wal-Mart Credit Card
programs, including to create and update their customer records for me, to assist them in better serving me, and to provide me with
notices of special promotions, catalogs and tailored offerings. I affirm that the information I have submitted is complete and truthful. I
authorize you to make inquiries you consider necessary (including requesting reports from consumer reporting agencies and other
sources) in evaluating my application, and subsequently, for purposes of reviewing, maintaining or collecting my account. I also
understand that the Wal-Mart
®
Discover
®
or Wal-Mart credit card agreement (“Agreement”) will govern my account, the terms of which
are hereby incorporated by reference into and made a part of this application and that THE AGREEMENT’S TERMS INCLUDE AN
ARBITRATION PROVISION WHICH MAY SUBSTANTIALLY LIMIT MY RIGHTS. My signature on this application represents my
signature on the Agreement. I understand that there is no agreement between us until you approve my application. After credit approval
and subject to the governing credit agreement, each applicant may use this account and will each be liable for all credit extended under
this account to any applicant or authorized user.
Federal law requires us to obtain, verify, and record information that identifies you when you open an account.We will use
your name, address, date of birth, and other information for this purpose.
Applicant’s Signature
Date
___________________________________________________
___________________________________________________
WISCONSIN RESIDENTS:
No provision of a marital property agreement, a unilateral statement under Sec. 766.59, Wis. Stats., or a court decree under Sec.
766.70, Wis. Stats., adversely affects the interest of the creditor unless the creditor, prior to the time credit is granted, is furnished a
copy of the agreement, decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred. We are
required to ask married residents of Wisconsin who have applied for individual credit to give us the name and address of
their spouse, regardless of whether their spouse may use the card. Please provide that information below:
____________________________________________________
________________________________________________
Name of Spouse
Address of Spouse
C77W (2/05) 5532-I [66535]
W02/05WM

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