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JCPenney  CREDIT APPLICATION

Print this application and mail or fax it to:

Synchrony Bank
P.O. Box 628048
Orlando, FL 32862-9048
Fax: 1-407-788-4057

If you live in Puerto Rico or U.S. Virgin Islands please mail it to:
Synchrony Bank
P.O. Box 364788
San Juan, PR 00936-1788

Applicant(s) please read the following ­

(1) Married applicants may apply for separate Accounts. After credit approval each Applicant shall have the right to use this Account to the extent of any credit limit set by the creditor and each Applicant will be liable either individually or together as we shall determine for all amounts of credit extended under this Account to any Applicant or Authorized User. (2) For Married Wisconsin Residents Only: If you are applying for an individual Account combine your financial information below.

APPLICANT INFORMATION

PLEASE PRINT IN BLUE OR BLACK INK

Your First Name Middle Initial Last Name Social Security Number
Street Address Apartment Number
City State Zip
Please mark (X) one  that applies: Previous Address Details: (only if at current residence less than 1 year)
Do you  Own Rent Other Years at Address Previous Address Previous Apartment
yrs mos 
Previous City Previous State Previous Zip Date of Birth
/ /
 Home Phone With Area Code Business Phone With Area Code E-Mail Address - Optional**
( (
Monthly Income - Total From All Sources* Driver License Number Driver License State Driver License Expiration Date
*You need not furnish alimony, child support, or separate maintenance income information if you do not want us to consider it in evaluating your application.  Include co-applicant income if applicable.
**By providing my e-mail address, I consent to receive e-mail communications about my account and authorize you to provide my e-mail address to JCPenney so I can receive special offers and updates.
CREDIT INFORMATION Please mark (X) all that apply:
Checking/Savings Checking Savings MasterCard Visa
CO-APPLICANT Also Responsible
for Account
AUTHORIZED BUYER Allows Person to
Purchase on Account
SPOUSE: Yes No
Name (First, Middle Initial, Last)  Occupation Business Phone With Area Code Years on Job
(   yrs mos   
NOTICE TO APPLICANT(S): A) DO NOT SIGN BEFORE YOU READ THE AGREEMENT OR IF THE AGREEMENT CONTAINS ANY BLANK SPACES. B) YOU ARE ENTITLED TO A COMPLETELY FILLED IN COPY OF THEAGREEMENT. C) YOU MAY AT ANY TIME PAY OFF THE FULL UNPAID BALANCE UNDER THE AGREEMENT WITHOUT INCURRING ANY ADDITIONAL CHARGE.
SIGNATURE Date CO-APPLICANT SIGNATURE  Date of Birth (Co-App)
    /      /  /  
CG88 (10/00) 2355

FOR WISCONSIN RESIDENTS ONLY

WISCONSIN RESIDENTS: No provision of a marital property agreement, a unilateral statement under Sec. 766.59, Wisc. Stats., or a court decree under Sec. 766.70 Wisc. Stats., adversely affects the interests of the creditor unless the creditor, prior to the time credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse obligation when the obligation to the creditor is incurred. Wisconsin law requires that we ask married residents of Wisconsin who are applying for individual credit to provide us with their spouses name and address. Please provide this information to us on or with this application.

We are required to ask married residents of Wisconsin who have applied for individual credit to give us the following information:

SPOUSE INFORMATION
First Name:
Middle Initial:
Last Name:
Address:
City:
State: Zip Code:


By signing this application, I ask that Synchrony Bank (you) issue me a credit card. I am providing this information both to you and to JCPenney. I also authorize and direct you to furnish information about me (including whether this application is approved or declined) and, if approved, information about my Account, to JCPenney (and its affiliates and licensees) for use in connection with the JCPenney Credit Card program, including to create and update their customer records for me, to assist them in better serving me, and to provide me with notices of special promotions, catalogs and tailored offerings. I understand that if I qualify for a credit card, you may open an account for me depending on my creditworthiness as determined by you. I affirm that the information I have submitted is complete and truthful and that my account will be used only for personal, family and household purposes. I authorize you to make inquiries you consider necessary (including requesting reports from consumer reporting agencies and other sources) in evaluating my application, and subsequently, for purposes of reviewing, maintaining or collecting my account. Upon my request, you will advise me of the name and address of each consumer reporting agency from which you obtained a report. I also understand that the credit card agreement will govern my account, the terms of which are hereby incorporated by reference into and made a part of this application and that my signing of this application represents my acceptance of the Agreement. I understand that there is no agreement between us until you approve my application, and that if approved, our Agreement will be deemed to have been made in Utah. I understand that I may apply for my own Account regardless of my marital status.

I ALSO UNDERSTAND THAT THE AGREEMENT CONTAINS AN ARBITRATION PROVISION WHICH MAY SUBSTANTIALLY LIMIT MY RIGHTS IN THE EVENT OF A DISPUTE, INCLUDING MY RIGHT TO LITIGATE IN COURT OR HAVE A JURY TRIAL, DISCOVERY AND APPEAL RIGHTS, AND THE RIGHT TO PARTICIPATE AS A REPRESENTATIVE OR MEMBER OF A CLASS ACTION. I MAY REQUEST THE CODE OF PROCEDURE, RULES AND FORMS OF THE ARBITRATION ASSOCIATION I SELECT BY CALLING THE TOLL FREE NUMBERS LISTED IN THE AGREEMENT.

NOTICE TO APPLICANT(S): (A) DO NOT SIGN BEFORE YOU READ THE PREVIOUSLY SHOWN AGREEMENT OR IF THE AGREEMENT CONTAINS ANY BLANK SPACES. (B) YOU ARE ENTITLED TO A COMPLETELY FILLED IN COPY OF THE AGREEMENT. KEEP A COPY OF THE AGREEMENT TO PROTECT YOUR LEGAL RIGHTS. (C) YOU MAY AT ANY TIME PAY OFF THE FULL UNPAID BALANCE UNDER THE AGREEMENT WITHOUT INCURRING ANY ADDITIONAL CHARGE.

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