Written Consent Form (individual or joint)
Thank you for your recent credit line increase request. We are required to obtain written consent before we can process a credit request on
accounts where a legally responsible cardholder is younger than 21 years of age or whose date of birth we do not have on file. The form
needs to be completed and returned to the address or fax number provided within 30 days or we will be unable to give further consideration
to your request. You will also receive a letter in the mail requesting this same information. Please respond only once.
Please Print All Information
Primary cardholder name________________________________________________________________________________________
Address______________________________________________________________________________________________________
City___________________________________________State __________________Postal Code______________________________
Full account number____________________________________________________________________________________________
Please complete the information below and fax it to us toll-free at 1.866.939.7135 or you may mail it to Card Services, PO Box 981814, El
Paso, TX 79998-1814. Please note that missing information may delay the processing of your request.
I am requesting the following:
Total Credit Line Increase to _______________ (in increments of $100)
I provide my consent to process the above listed request(s).
Primary cardholder date of birth (MM/DD/YY): ____________
Primary cardholder signature: __________________________________________________Today’s date:______________________
If you share your account with another person who is also legally liable for the account balance, please have them provide their written
consent as well:
NOTICE TO COSIGNER (guarantor or co-applicant):
I also consent to the credit request contained within this letter.
Cosigner date of birth (MM/DD/YY): ________________________
Cosigner name (Please print): _________________________________
Cosigner signature: ________________________________________Today’s date:__________________
