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HOME CLIMATE

CONSUMER APPLICATION – L71 HCL

(toll free) REVOLVING PHONE:

1-800-300-5189

(toll free) REVOLVING PHONE:

1-800-300-5189

REVOLVING FAX:

1-888-679-5200

REVOLVING FAX:

1-888-679-5200

Email Address *

Contractor # *

Account # *

Amount Requested $ *

Applicant’s Primary ID (Type, Number, Issuing, State) Exp. *

Sec. ID (Credit Type and Issuer) Exp. *

Joint Primary ID (Type, Number, Issuing, State) Exp. *

Sec. ID (Credit Type and Issuer) Exp. *

APPLICANT

First Name: *

First

M. Initial: *

Last Name: *

Mailing Address: *

APT # *

Do You (Select one): *

Own

Parents / Relative

Rent

Other

City: *

State *

Zip *

Years at Residence: *

Country *

Social Security Number: *

Birth Date: *

(MM/DD/YYYY)

Home Phone: *

If the above address is a PO Box, you must provide a street address for yourself or a contact person: *

City: *

State *

Zip *

Cell/ Other Phone Where We May Call You: *

Your Employer: *

How Long (Yrs) *

Total Monthly Income $ *

Business Phone: *

E-Mail Address *

By providing an E-Mail address, I consent to receive E-Mail Communications about my Account and authorize you to provide my E-Mail address to GE Money so that I may receive such communications, offers and updates.

NOTE: Alimony, child support or separate maintenance payments need not be disclosed unless relied upon for credit.

First Name: *

Address: *

City: *

State *

Zip *

Home Phone: *

For WI residents, if you are applying for individual credit with someone who is not your spouse, combine your and your spouse’s financial information on this application form.

JOINT APPLICANT

First Name: *

M. Initial: *

Last Name: *

Mailing Address: *

APT # *

Years at Residence: *

City *

State *

Zip *

Social Security Number: *

Home Phone / Other Phone: *

Birth Date: *

Your Employer: *

How Long (Yrs) *

Total Monthly Net Income* $ *

Business Phone: *

APPLICANT / JOINT APPLICANT SIGNATURES

I am providing the information in this application to GE Money Bank("GEMB")and to contractors ("contractors")that accept the home climate credit card ("card") and to programe sponsors,and asking GEMB to issue me a card. By applying for this account ,I authorize and agree that:

GEMB may furnish this and other information about me (even if my application is denied)and my account to contractors and programe sponsors (and their respective affiliates)to create and update their records.and to provide me with service and offers.
GEMB my make inquiries it considers necessary (including requesting reports from consumer reporting agencies and other sources)in evaluting my application and for purposes of reviewing .maintaining or collecting my account
If my application is approved ,the GEMB card Agreement ("Agreement"). a copy of which is attached will be sent to me and will govern my account.
Among other things ,the Agreement : (1) INCLUDES AN APPLICATION PROVISION THAT MAY LIMIT MY RIGHTS UNLESS REJECT THAT PROVISION UNDER THE AGREEMENT'S INSTRUCTIONS: and ( 2 )Makes each applicant responsible for paying the enter amount of credit extended :and (3)grant GEMB a secuirty interest in the goods purchsased on the acount as permitted by law .
I consent to GEMB and any other owner or server of my acount contacting me about my account , including using any contact information or cell phone numbers provide (whether now or in the futher )and i consent to the use of any aotomatic telephone dialing system and /or an prerecorded voice when contacting me . event if I am charged for the call under my phone plan
I also agree that if my application for a card is no approved by GEMB . the contractor or GEMB may application information to service finance compnay . LLC 1956 NE 5th Avenue . Boca raton . FL 33431 .Its assignee (SFC)and that SFC may offer me cradit and that I authorize SFC to make inquiries they consider necessary . including requesting report from consumer reporting agencies and other sources in evaluating my credit .
This application and the agrrement are governed by federal law and Utah law (to the extent that state law applies )

Federal law requires GE Money Bank to obtain, verify and record information that identifies applicants when opening an account. GE Money Bank will use applicant's name, address, date of birth, and other information for this purpose. Please note that you must reside in the United States and be 18 years or older to apply.

If you are human, leave this field blank.

To find out about changes in the terms of the attached agreement, write to us at GEMB, P.O. Box 6160, Rapid City, SD 57709-6160.

HOME CLIMATE

CONSUMER APPLICATION – L71 HCL

(toll free) REVOLVING PHONE:

(toll free) REVOLVING PHONE:

REVOLVING FAX:

REVOLVING FAX:

APPLICANT

JOINT APPLICANT

APPLICANT / JOINT APPLICANT SIGNATURES

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