USA OPTIMUM PLATINUM

Title: First Name:

Middle Initial

Last Name:

Street Address Line 1:

Street Address Line 2:

City:

State:

Zip Code:

Home Phone (ie: 999-555-1212):
- -

Email: (i.e: name@url.com)

Cell Phone (ie: 999-555-1212):
- -

I don't have a cell phone

Date of Birth:

Yes

- I have an active checking/savings account.

When I complete the application on the following pages of USA Platinum, USA Credit will debit my checking account for my one-time $149.95 Membership Fee. It will appear as a debit by USA Credit on my banking statement.

By clicking the SUBMIT button, I agree to the USA Platinum Privacy Policy and to receive personal finance and other daily email offers from the 'Opt-in-Credit' list and our marketing partners, including the CreditDaily newsletter.

*See Terms and Conditions.