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Credit Card Application Form

1 Personal Information

Full Name

First Name

Last Name

Date of Birth

MMDDYYYY

Social Security Number

Annual income $

2 Contact Information

Street Address or APO/FPO Rural Route Address

Home Address

House Number

Street Name

Apt/Ste

Rural route

Box number

City

State

Zip Code

Phone Number

Email Address

3 Submit Application

Electronic Consent

You must read the disclosures presented in the Electronic Consent section of the Terms and Conditions box below prior to checking the consent box. Please also read the Credit Card Agreement. Privacy statement and other information presented in the Terms and Conditions box prior to submitting this application and print a copy for your records.

Each person submitting this application/solicitation (“I,” “me” or “my”) agrees and certifies that I: (1) read and agree to the disclosures provided, (2) supplied true and correct information, (3) am applying to Comenity Bank P.O. Box 182273, Columbus, OH 43218-2273 (“Bank”) for either a(n) ALL Rewards Mastercard® Credit Card Account or a(n) ALL Rewards Credit Card Account and the Bank will decide which account, if any, to offer me, (4) authorize the Bank to obtain my credit reports, (5) understand that my account, if approved, will be governed by the Credit Card Agreement, (6) authorize the Bank to share my application information with Loft.

I understand that by checking this box and clicking “Submit,” I agree to the Terms and Conditions, acknowledge receipt of the Privacy Notice, consent to electronically receive documents, and electronically sign this application/solicitation.

By clicking Submit below I agree to join the ALL Rewards Loyalty Program and agree to its Terms and Conditions and the ANN INC. Privacy Policy. I also understand that by clicking Submit I will receive emails regarding the ALL Rewards Program from ANN INC.

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