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Your
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Finalize your application by reviewing the
information provided below and
completing the blank 9elds.
Raul, You're Pre-
Approved!
Personal Information (Required)
First Name*
RAUL
Middle Initial
Last Name*
VERARDY
Su4x
EDIT
Mailing Address*
3261 W 96TH AVE
Apt/Unit #
City*
WESTMINSTER
State
Colorado
*
ZIP Code (XXXXX)*
80031
EDIT
Please complete the blank 0elds.
Email Address (*****@******.***)
************@*****.***
We use email to alert you if there's a problem
during the application process, when we mail
your new credit card as well as notify you about
special o9ers, new services and important
account information.
*
Main Phone Number (XXX-XXX-XXXX)
You con=rm you are the owner of this phone
number or that the owner authorized you to
provide this number. You are providing express
consent authorizing Credit One Bank and its
authorized agents to contact you at this number
for all your accounts for any lawful purpose with a live operator, automatic telephone dialing
systems (auto-dialer), prerecorded and arti=cial
voice message, text/SMS message or other
means. Authorization may be revoked in writing
as described in the card agreement.
*
Your Total Monthly Income
$4,000
Alimony, child support, or separate maintenance
income need not be revealed if you do not wish
to have it considered as a basis for repaying this obligation.
*
Calculate Your
Monthly Income
Social Security Number (XXX-XX-XXXX)
*
Date of Birth (MM/DD/YYYY)*
02 / 26 / 1980
Click on a Card Design to make your
selection (Required)
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(Free)
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Optional Credit Protection Program
Protect your new account with
these beneats:
Credit Protection will help
when you experience
setbacks in life and avoid
negative impact to your
credit report
If you become involuntarily
unemployed or disabled,
no need to worry about
making payments for up to 6
bene9t payments
In case of loss of life, the
account may be eligible for a
balance payob up to $10,000
YES, I want to protect my new account
Add an Authorized User
Yes, I want to add a second card for an
Authorized User
Consumer Acknowledgement
(Required)
You understand that by selecting the 'I Agree'
button immediately following this notice, you
are providing 'written instructions' to Credit One Bank, N.A. under the Fair Credit Reporting Act
authorizing Credit One Bank, N.A. to obtain
information from your personal credit proEle or
other information from one or more credit
reporting agencies ("Consumer Report"). You
authorize Credit One Bank, N.A. to obtain your
Consumer Report to validate your identity and
determine credit worthiness. Please print this
authorization for your records. Tap here to print
this authorization for your records.
By selecting 'I Agree' below, I also acknowledge
that I have read the Disclosures and Terms &
Conditions included with the oLer I received
and agree to be bound by those terms and
conditions.
Yes, I Agree
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