FEDERAL CREDIT APPLICATION INSURANCE DISCLOSURE:
I have applied for an extension of credit with you. You are soliciting,
offering, or selling me an insurance product or annuity in connection with
this extension of credit. FEDERAL LAW PROHIBITS YOU FROM CONDITIONING
THE EXTENSION OF CREDIT ON EITHER: 1) My purchase of an insurance
product or annuity from your or from any of your affiliates; 2) My
agreement not to obtain, or a prohibition on me from obtaining, an
insurance product or annuity from an unaffiliated entity. By signing, I
acknowledge that I have received a copy of this form on today's date.
Unless this disclosure is provided electronically or I have applied for
credit by mail, I also acknowledge that you have provided this disclosure
to me orally.
I CERTIFY that everything
I have stated in this application and on any attachments is correct. You
may keep this application whether or not it is approved. By clicking the
"Submit" button below, I authorize you to check my credit and employment
history and to answer questions others may ask you about my credit record
with you. I understand that I must update credit information at your
request if my financial condition changes.