Certegy Check Services, Inc
Certegy Their Gold Application

Hi, I had a problem at KMart last week because certegy said that I had too many high amount checks outstanding. What they consider to be high amounts is $4.17 and $36.15. When I talked to them they told me that I should fill out their "Gold Application" and I would never be denied again. I have since refused to shop at Kmart, and went and got a copy of the application, and I am posting it here so you can see the type of information that they are requesting in writing.

Certegy Gold Application

This application may be your ticket to quick and convenient check writing. Mail it today!

To apply, print out this application, complete U sing Captial Letters, sign the application, i nclude a voided check and mail to:

Certegy Check Services, Inc., Attention Certegy Gold, P.O. Box 30046, Tampa, FL 33630-3046.

Please remember to include a voided check with this application

Individual Information: For Personal and Company Checks. (*For Personal Checks Only). Please Use Capital Letters Only

First N Last N MI

Home Ph#: () - - CellPh#: () - -

Street Add: Apt/Unit #:

City: St: Zip: -

E-Mail:

*Do you? Own Rent How Long? Years Months. If less than one year at current address, please provide previous

*Street Address: *Apt/Unit #:

*City: *St: *Zip: -

Drivers License or State ID (required): State: #

Exp. Date: (mm/dd/yyyy) Date of Birth: SSN:

Employers name: Employers Main Ph# () - -

Position/Title: Number of years employed Check if self-employed

*Household income: $0 - $25,000 $25,001 - $50,000 $50,001 - $75,000 $75,001 - $100,000 over 100,001

Business Information: Business Section is for Company Checks Only. Please Use Capital Letters Only

Company Name: FEIN. Tax ID#:

Street Add: Suite #:

City: St: Zip: -

Work Ph#: () - Ext: () URL:

E-mail: Sole proprietorship Partnership Corp

Banking Information: (You must include a blank check with "VOID" written across it for each checking account listed.)

Routing # of Your Financial Institution: Account #:

Account Type: Checking Money Market Other Name of financial institution:

Date Account opened: Month Year: Average daily balance: Overdraft protection? Yes No

If joint account, please print joints following information

First N: Last N: MI:

Home Ph#: () - - Cell Ph#: () - -

Street Add: Apt/Unit #:

City: St: Zip: -

Drivers License or State ID (required): State: #

Exp. Date: (mm/dd/yyyy) Date of Birth: SSN:

Additional Checking Accounts:

Routing # of Your Financial Institution: Account #:

Check Type: Personal Business Account type: Checking Money Market Other

Date account opened: Month Year Average daily balance: Overdraft protection? Yes No

This application is the sole property of Certegy Check Services, Inc. (Certegy). Participating in the Certegy Gold Program is subject to terms, conditions, and rules that Certegy may, at our discretion, adopt

From time to time. It is understood that we will verify the above information to determine eligibility. Your signature below authorizes your financial institution to release information concerning the above

Accounts to Certegy for this sole purpose.in consideration of your acceptance into the Certegy Gold Program, you also agree to pay Certegy a service charge for each dishonored check in accordance with

The laws in your state. Certegy reserves the right to remove you from the Certegy Gold Program if one or more of your checks are dishonored.

Your name: (please print) % Your signature: % Date:%

Certegy Check Services, Inc. 1.800.282.8720 certegy. Gold@certegy.com www.certegy.com Become a member today. We invite you to join the millions of good check writers who are already receiving the benefits of Certegy

Gold. If you manage your financial affairs responsibly, then this offer may be yours for the taking. There is no fee, no card to carry, and you are guaranteed complete confidentiality. Just complete this brief application. Upon approval,

Well notify you of your new Certegy Gold membership status.

# of years in business: Income Range: $0-$50,000 $50,001-$100,000 $100,001-$200,000 $200,001-$500,000 $500,001

Company: Certegy Check Services, Inc
Country: USA
State: Florida
City: Tampa
Address: P.O. Box 30046
Phone: 8002828720

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