Application Form For A Jcpenney Credit Card

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Application for a JCPenney Credit Card

Complete and mail to

For residents in Puerto Rico and US Virgin Islands:

JCPenney/GE Money Bank

PO Box 981094

PO Box 364788

El Paso, TX 79998-9916

San Juan, PR 00936-4788

Applicant Information

Please complete entire application in blue or black ink.

Missing or inaccurate information may delay or adversely affect credit decision.

First Name

Middle Initial

Last Name

Date of Birth (mm/dd/yy)

❑ Own

Street Address (Street Name and Number Required)

City

State

Zip

❑ Rent

❑ Other

❑ Checking

Previous Address (If less than one year)

City

State

Zip

❑ Savings

❑ Both

Social Security Number

Home Phone

Business Phone

Cell / Other Phone Where We May Call You

Annual Income from all Sources*

*You need not furnish alimony, child support, or

separate maintenance income information if you do

not wish us to consider it in evaluating your application.

Include co-applicant income if applicable.

By providing my E-mail address I consent to receive

E-Mail Address (Optional)

E-mail communications about my account and authorize

you to provide my E-mail address to JCPenney so

I can receive special offers and updates.

For Verification Purposes Please Provide the Following:

❑ Driver’s License

Mother’s Maiden Name

DL or SI Number

State

❑ Sate Issued ID

*FOR WI RESIDENTS ONLY: If you are applying for an individual account, combine your and your spouse's financial information.

Co-Applicant

❑ Also Responsible for Account (Signature Required Below)

Authorized User

❑ Allows Person to Purchase on Account

❑ Spouse ❑ Other

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.

JOINT APPLICANT ONLY: By signing below, you agree that the Applicant’s Home Address is YOUR street address.

First Name

Middle Initial

Last Name

Street Address (Street Name and Number Required)

City

State

Zip

Business Phone

Date of Birth (mm/dd/yy)

Social Security Number

For Verification Purposes Please Provide the Following:

❑ Driver’s License

DL or SI Number

State

❑ Sate Issued ID

By signing this application, I ask that GE Money Bank (“you”) issue me a JCPenney Credit Card. I am providing this information both to you and to JCPenney. 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 JCPenney (and its affiliates and licensees) for use in connection with the JCPenney Credit Card program, 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 JCPenney 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 my 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

Co-Applicant 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

City

State

Zip

CG88 (7/03) 5018-I Rev 2/05 [67120]

W7/03JP