Application for Blair Credit Card

Issued by Comenity Capital Bank

First Name

Last Name

Address Line 1

Address Line 2 (Optional)

City

State

ZIP Code

Email Address

Mobile Phone

Alternate Phone

By providing your contact information above, including any cellular or other phone numbers, you agree to be contacted regarding any of your Comenity Bank or Comenity Capital Bank accounts via calls to cell phones, text messages or telephone calls, including the use of artificial or pre-recorded message calls, and calls made via automatic telephone dialing systems, or via e-mail.

Personal Identification

Date of Birth

MM/DD/YYYY

Electronic Consent

Content Information and Rules

Comenity Capital Bank issues Blair Credit Card Accounts. If you wish to proceed with this online application/solicitation, you will be providing your personal information to Comenity Capital Bank.

To accept you must:

• Be at the age of majority in your state or territory

• Have a valid government-issued photo ID

• Have a valid government issued tax identification number

• Have a street, rural route, or APO/FPO mailing address. We do not accept PO Box mailing addresses

IMPORTANT INFORMATION ABOUT OPENING AN ACCOUNT:

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth or other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

CA Residents: If you are married, you may apply for a separate account.

NY, RI, and VT Residents: We may order credit reports in connection with processing applications and any update, renewal or extension of credit. Upon request, we will tell you the name and address of any consumer-reporting agency that furnished a report on you. You consent to the obtaining of such reports by signing or otherwise submitting an application or solicitation.

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.

WI Residents: No provision of marital property agreement, unilateral statement under Section 766.59 or court decree under Section 766.70 adversely affects the interest of Comenity Capital Bank, unless the Bank, prior to the time 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 Bank is incurred.

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Application for Blair Credit Card

Issued by Comenity Capital Bank

Personal Identification

Electronic Consent

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