Credit Application Form

Credit Application

Welcome to the Quiet Zone Online Credit Application Center operated by GE Money Bank,
the issuer of the credit card. We encourage you to read the GE Money Bank Privacy Policy
and Web Site Usage Agreement, which govern the use of the Credit Application Center. Please note that
this privacy policy and web site usage agreement may differ from those of any websites that you have previously
visited. Please note that only US residents 18 years or older can apply online.

Your security is important to us. We take great care to protect your information by using 128-bit secure socket layer technology.

* First Name

Middle Initial

* Last Name

* Address 1

Apt. Number

* City

* State

* Zip Code

* Home Phone Number

Email Address

Cell Phone Number

Business Phone Number

* Date Of Birth

* Social Security Number

* Drivers License
Number or ID

* State

* Expiration Date

* Monthly Net Income $

* Housing

(Alimony, child support or separate maintenance income need not be disclosed unless relied upon for credit.)

Optional Account Security - Optional Account Security cancels your Quiet Zone Credit Card account balance up to $10,000 in the event of:

Unemployment

Nursing Home Care

Disability

Loss of Life

Hospitalization

Approved Leave of Absence

Click here for Benefits and Features	Click here for FAQ

I acknowledge that I do not need to purchase Account Security to obtain credit. Per the Account Security agreement, I agree that you may bill my Quiet Zone account a monthly fee of $1.50 per $100 of the average daily balance on my account. I may cancel at any time.

By clicking the enroll button below, I intend to purchase optional Account Security and this constitutes my signature

* Account Security

Yes, Enroll Me

No, Thank You

Co-Applicant Information - Federal law requires us to obtain, verify and record information that identifies you when you open an account. We will use your name, address, date of birth and other information for this purpose.

Check 'Yes' only if applying jointly for credit. Co-Applicant will also receive a "Quiet Zone Credit Card" upon approval.

Important Information - Please see below for key terms, consent to Electronic Communications, Initial Disclosure Statement and Privacy Policy. You may view and print the terms and conditions here.

* Do you have a co-applicant?

Yes

No

First Name

Middle Initial

Last Name

Address 1

Apt. Number

City

State

Zip Code

Home Phone Number

Email Address

Cell Phone Number

Business Phone Number

Date Of Birth

Social Security Number

Drivers License
Number or ID

State

Expiration Date

Monthly Net Income $

Housing

APPLICANT and CO-APPLICANT: We need your signature(s) below

I am providing the information in this application to GE Money Bank (“GEMB”), to The Quiet Zone, to dealers (“Dealers”) that accept the Quiet Zone Card (“Card”) and to program sponsors, and asking GEMB to issue me a Card. By applying for this account, I authorize and agree that:

GEMB may furnish this and other information about me (even if my application is denied) and my account to The Quiet Zone. and to Dealers and program sponsors (and their respective affiliates) to create and update their records, and to provide me with service and special offers.
GEMB may make inquiries it considers necessary (including requesting reports from consumer reporting agencies and other sources) in evaluating my application, and for purposes of reviewing, maintaining or collecting my account.
If my application is approved, the Quiet Zone Card Agreement (“Agreement”) will be sent to me and will govern my account.
Among other things, the Agreement: (1) INCLUDES AN ARBITRATION PROVISION THAT MAY LIMIT MY RIGHTS UNLESS I REJECT THAT PROVISION UNDER THE AGREEMENT'S INSTRUCTIONS; and (2) makes each applicant responsible for paying the entire amount of credit extended; and (3) grants GEMB a security interest in the goods purchased on the account as permitted by law.
I consent to GEMB and any other owner or servicer of my account contacting me about my account, including using any contact information or cell phone numbers I provide, and I consent to the use of any automatic telephone dialing system and/or an artificial or prerecorded voice when contacting me, even if I am charged for the call under my phone plan.
This application and the Agreement are governed by federal law and Utah law (to the extent that state law applies).

Federal law requires us to obtain, verify and record information that identifies you when you open an account. We will use your name, address, date of birth, and other information for this purpose

I acknowledge that by clicking the "Accept & Submit", I am indicating my intent to sign this credit card application and that this shall constitute my signature.

Your security is important to us. We take great care to protect your information by using 128-bit secure socket layer technology.

Privacy Policy | Web Site Usage Agreement

* Indicates Response Required