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                                                                        Preferred Customer Card   
Instant approval up to $6500 - No Annual Fee - No Hassle Credit - Easy Application
(Print and fill out the basic information, mail to us at 1000 S Saint Charles, Jasper IN 47542
or fax to 877-812-3386 or call 800-222-4303 for quick processing) - It will take literally a few minutes.
   
  For detailed terms & current lending rates, write: GE Capitol Consumer Card Col, P.O. Box 276, Dayton OH  45401-0276, or call
800-333-1071
 
 
 
  Name (Full) ___________________________________________________________________DOB________________
 
 
 
  Current Address_____________________________________________________# of Dependants________________
 
 
 
  City______________________________________________State___________________Zip_____________________
 
 
 
  Home Phone____________________Salary (Annual)____________Email Address______________________________
 
 
 
  Social Security No__________________________________Cell/Other Phone_________________________________
 
 
 
  Housing Information (Please Circle Response)_____OWN_____________RENT_______________OTHER____________
 
 
 
  Years at Residense_____________________Mortgage/Rent Payment_______________________________________
 
 
 
  Employeers Name_______________________________________________Employeers Phone____________________
 
 
 
  Years at Current Employeer (previous Employment time if less than 2yrs)____________________________________
 
 
 
  Drivers License #________________________Issuing State___________Exp Date____________________________
 
 
  Signature______________________________________________________________  Date_____________________