Layout(Applicant Initials)(Co-Applicant Initials)LayoutFirst NameLast NameMiddle NameMother's Maiden Name (For Security Purposes)LayoutStreet AddressYears at AddressCityStateSelect Your StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZIP CodeLayout

Social Security NumberHome PhoneLayout (copy)

Layout (copy) (copy)Previous addressCity (If less than 3 yrs at current address)State Select Your StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLayout (copy) (copy) (copy)Zip CodeYears at AddressLayout (copy) (copy) (copy) (copy)Name of Employer or Source of IncomeBusiness PhonePosition or TitleNo. of YearsLayout (copy) (copy) (copy) (copy)Gross Monthly Income *Other Income *Source of Other Income

CO-APPLICANT/SPOUSE/AUTHORIZED USER

Name of Co-Applicant/Spouse/Authorized UserLayout (copy) (copy) (copy) (copy) (copy)Social Security Number

Business Employer or Source of Income LayoutGross Monthly Income *Other Income *Source of Other Income *

SIGNATURES

Loan Application Certification:

Everything that I/we have stated in this application is correct to the best of my/our knowledge. I/We understand that this application will remain your property and you will retain it whether or not this application is approved. You agree to our terms and conditions.

This application is submitted to obtain credit. You are authorized to check my/our employment history and to ask questions about my/our credit experiences. Without limiting the foregoing, I/we authorize you to make inquiries (including requesting reports from consumer credit reporting agencies and other sources) to verify my/our identity and determine my/our eligibility for credit, and subsequently in connection with any extension of credit, update, renewal, review or collection of my/our account or for any other legal purpose. I understand that, on my/our request, you will tell me/us whether or not you requested a credit report and the names and addresses of any credit bureaus that provided you such reports. I/We also authorize you to release information to others about my/our credit history with you.
I/We understand that you may report information about my/our account to credit bureaus. Late payments, missed payments, or other defaults on my/our account may be reflected in my/our credit report.

State Law Disclosures:

CA Residents: Regardless of your marital status, you may apply for credit in your name alone. If this is a joint account, after credit approval each applicant has the right to use this account to the extent of any credit limit set by the creditor, and each applicant may be liable for all amounts of credit extended under this account to any joint applicant.

DE and MD Residents: Service charges not in excess of those permitted by law will be charged on the outstanding balances from month to month  NY Residents: New York residents may contract the New York State Banking Department (1-800-518-8866) to obtain a comparative listing of credit card rates, fees, and grace periods. OH Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.
Married WI residents: No provision of a marital property agreement, a unilateral statement under section 766.59, or a court decree under section 766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement, or decree or has actual knowledge of the adverse provision when the obligation to the credit is incurred.

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Layout (copy) (copy)Signature if Co-Applicant (If applicable)Clear Signature

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Signature: Clear Signature

I agree to these terms and conditions Terms and Conditions is entered into by and between 9X GROUP, LLC, a financial institution to issue credit cards, hereinafter referred to as "Issuer," and the Applicant, hereinafter referred to as "Cardholder." Click HERE to view and get copy of Terms and Conditions.

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