USA Platinum

Elite Terms

By filling out the form, you agree to the following Privacy Policy and agree to receive personal finance and other daily email offers from our marketing partners, including the CreditDaily newsletter.

Title: First Name:

Middle Initial:

Last Name:

Street Address Line 1:

Street Address Line 2:

City:

State: Zipcode:

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

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

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

Social Security Number
(ie:888-55-3333):
- - Why?

Month of Birth:

Day of Birth:

Year of Birth

Mother's Maiden Name
(for Security):

Primary Account Holder Banking Information For Payment of
Membership Fee and Elite Services

Routing number:
must be 9 digits exactly

Bank Account Number:

Please specify which account:

Checking

Savings

By checking this box, I have read, understand, agree to and accept the Terms & Conditions. of the USA Credit Shopping Card Member Agreement.

Upon approval I will be entitled to receive the USA Credit membership benefits, including Elite Services, and will receive my $2,500 Unsecured USA Platinum Shopping Card. I authorize USA Credit to debit my bank account for my one-time $149.95 Membership Fee. This one-time fee entitles me to receive my $2,500 Unsecured USA Platinum Shopping Card for use exclusively at the USA Credit Shopping Club. This one-time fee will be deducted as soon as one (1) business day after I am approved for the $2,500 Unsecured USA Platinum Shopping Card. I acknowledge and agree to the Terms & Conditions of the USA Credit Shopping Card Member Agreement. I have monthly income of at least $1,000 and I have the ability to make a monthly payment of as much as $250 if I utilize my entire credit line.

Further, I acknowledge and agree to the Elite Services terms of the USA Credit Shopping Card Member Agreement and I authorize USA Credit to debit my bank account $19.95 for my Elite Services, every thirty (30) days in which I maintain my Elite Services. Each debit will appear on my banking statement and I will deduct each amount from my bank account. The first debit will occur as soon as thirty (30) days from today.s date. I may cancel my Elite Services at any time by contacting USA Credit member services at 1-888-834-1815 or at memberservices@usacdt.com. If I cancel my Elite Services after a monthly debit has occurred, I will cancel subsequent debits, but will not receive a refund for the current month.

To help us out, please let us know what you plan on doing in the next six months:

Do you want to become debt free?



Alternate Phone Number: - -
Best Time to Call You:	Total Unsecured Debt:
I agree to the Privacy Policy & would like a Debt Professional to call and discuss the best way to ELIMINATE my credit card debt.By selecting YES, I consent to be phoned by a USA Debt Services representative. Yes No Privacy Policy

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.

NO THANKS