Complete

Your

Application

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 (ad3sm1@r.postjobfree.com)

ad3sm1@r.postjobfree.com

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)

720-***-****

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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Ruby Red

(Free)

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(Free)

Sterling Silver

(Free)

Royal Blue

(Free)

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

In order to continue, you must agree to the Required sections above.

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