Credit Application

Name (First, Middle, Last):	Date of Birth:	Social Security Number:
Present Address:	City, State, Zip	Home Phone Number:
Previous Address:	Time at Present Address	Own Rent Other Parents
Name of Present Employer:	Employer Phone Number:	Time at Job:
Name of Nearest Relative not Living with You / Relation:	Relative's Phone Number:	Your DL No. and State:

This application is submited to obtain credit privileges and I/We (hereinafter "I" or "me") certify that all information is true and complete. I authorize Bank One, NA ("Bank One") To retain property of this application, to rely on the foregoing to check and verify my credit, employment and salary histories to secure follow-up credit reports concerning my creditworthiness and to exchange information about my account with proper persons, creditors, and credit bureaus. I Authorize my employer (present or future) Bank and other references listed to release and/or verify information to Bank One at any time. I aknowledge that this application is subject to approval of credit and acceptance by Bank One at its principal office in Dayton, Ohio, and that any credit extended pursuant hereto is extended by Bank One from its principal office in Dayton, Ohio. If this application is approved, I agree to abide by the terms of the account Agreement and Disclosure Statement which shall be issued by Bank One from time to time. SECURITY INTEREST BEING GRANTED TO BANK ONE: I AM GRANTING TO BANK ONE A PURCHASE MONEY SECURITY INTEREST IN ACCORDANCE WITH THE UNIFORM COMMERCIAL CODE IN AL MERCHANDISE CHARGED TO THE ACCOUNT INCLUDING, BUT NOT LIMITED TO, FURNITURE, ELECTRONIC GOODS, HOUSEHOLD APPLIANCES, JEWELRY, HOME IMPROVEMENT MATERIALS, AND OUTDOOR POWER EQUIPMENT. I AKNOWLEDGE RECEIPT OF THE ACCOUNT AGREEMENT AND DISCLOSURE STATEMENT WHICH CONTAINS ADDITIONAL INFORMATION IN CONNECTION WITH THE PURCHASE MONEY SECURITY INTEREST GRANTED TO BANK ONE.
Your E-Mail Address:	I Agree with the terms and Conditions Stated Above