Drivers License _ by Levone


									                              Peavine Finance Program 
                                      Program Highlights
                              Interest is Credit Driven (7.99% ‐ 20.99%) 
                                           No Money Down 
                                            No Annual Fees 
                                       No Pre‐payment Penalty 
                                          Fast Credit Decision 

Application Process
Please fill-out the credit application and fax the application only to PEAVINE FINANCE at (877) 320-7456
(fax cover sheet not required) or email application to Applications are accepted
24/7 but will be processed Monday – Friday, 8:00 AM to 5:00 PM PST. For any additional questions, please
email us at or call during normal business hours PST at (775) 229-8171 to
speak with a Service Representative.
Approval Process
Once approved you are automatically sent a credit card in the mail within 24 hours. It takes approximately
5-7 business days to receive your credit card in the mail. When you receive the credit card in the mail
simply activate it by calling the toll free number listed. You can now place your order with IonWays!

A minimum requirement to apply is 630 FICO Score.
Please note that during the application process, a number of factors will be taken into consideration. The
minimum requirement above is intended as a guide. Therefore, there is no guarantee that applicants that
meet all of the minimum requirements will be approved for financing.

For a faster response to your application please apply on-line at

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Peavine Finance                                                            Applicant Information
                                                                                      (Please Print)
First Name                     Middle Init.                       Last Name                                                  Date of Birth       Social Security No.

Present Address                                                                City                                  State          Zip                   Phone

Drivers License #                             State           Exp. Date        Mothers Maiden Name*               Email Address (you must have a valid email address)

                                                                         Employment Information
Employment Status                      Employer Name                                                               Occupation

Length of Employment                   Business Telephone Phone
                                                                                                                       THIS FIELD IS BLANK
___________Yrs ___________Mo

                                                                           Financial Information
Annual Salary                    Other Household Income                       Housing Status (Circle One)     Housing Payment                       Length at Current Residence?
$                                $                                        OWN HOME / RENT / OTHER             $ ________________ /Month             ___________Yrs ___________Mo
 Do you have a Debit or Checking Account?       Do you have a Saving, IRA or
                                                Money Market Account?        YES / NO                                          THIS FIELD IS BLANK
                  YES / NO                      (Circle Answer)

                                                                      Authorized User Information
                                                                                (Signature not required)
First Name                                            Last Name
                                                                                                                               THIS FIELD IS BLANK

                                                                                  Line of Credit
                                                            Ionizer                        Amount Requested        Luminous Fee                     Total Amount Requested
                THIS FIELD IS BLANK
                                                                                           $                  +    $ 299.00                  =      $

                                                                         Identification Information
Card Type (Circle One)                                Card Number:                                                                                  Card Exp. Date

                                                      Name as on card:
* In order to verify your identity, please complete this section. A valid credit card in your name and your state driver's license information is required. There is no
fee for submitting this application.


By completing the credit application form and submitting it, I acknowledge that the application information provided is true and correct to the best of my 
knowledge.  I also acknowledge that I have received proper authorization by the co‐applicant to include the co‐applicant's information on this application.  I 
agree to give Health One Financial and / or their lending companies, including, but not limited to, Banks, Finance Partners, Credit Card Issuers and other types of 
companies, authorization to access my credit profile for review purposes. _______Initials 
I authorize Health One Financial to share the credit decision of my Health One account with Peavine Finance. _________Initials 
I certify that I have read and understood both the disclosures and terms & conditions here and agree to the terms of this application. I understand that that I will 
be assessed a one time Program Fee of $299, payable to Health One Financial for securing my financing.  I understand this Program Fee will be billed to my 
Health One account or a credit account of my choice and that if I cancel my Health One account, the Program Fee will be waived. No additional fees will be 
charged for future expenditures against your Health One account. _______Initials 

X ____________________________________________________________________________________________________________
 APPLICANT’S SIGNATURE                                                               DATE

ACCOUNT INFORMATION:              Account Number: ___________________________________________                            TO SUBMIT FOR FUNDING, Fax ONLY
(OFFICE USE ONLY)                 Credit Limit: ____________________ APR: ______________________                         the application to 1-877-320-7456

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                                                                Visa® Platinum Card Terms and Conditions

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information
that identifies each person who opens an account. What this means to you: When you open an account, we will ask for your name, street address (P.O. Boxes are not
allowed under Federal law), date of birth and other information (including your Social Security or Tax Payer Identification Number) that allow us to identify you. We may
ask to see your driver's license or other identifying documents.
Your APR may increase if you fail to make timely payments to another creditor as reflected in your credit report. All Account terms are governed by the
Cardmember Agreement sent with the card. Account and Cardmember Agreement terms are not guaranteed for any period of time, we may change all terms,
including APRs and fees, in accordance with the Cardmember Agreement and applicable law.

                                                                         Disclosure of Credit Card Terms
              Summary of Visa® Platinum Card Account Terms

                      Annual Percentage Rate for Purchases1      7.99% to 20.99% variable
                                                                 (Subject to a minimum APR of 7.99% to 20.99%)

                             Other Annual Percentage Rates1      Balance Transfers:
                                                                 7.99% to 20.99% variable
                                                                 (Subject to a minimum APR of 7.99% to 20.99%)
                                                                 Cash Advances:
                                                                 20.99% variable
                                                                 (Subject to a minimum APR of 20.99%)
                                                                 Delinquency Rate2:
                                                                 28.99% variable
                                                                 (Subject to a minimum APR of 28.99%)

                                    Variable Rate Information    Your annual percentage rate may vary monthly. The rate is determined by adding a margin to the Prime Rate3.
                                                                 The margin used is as follows:
                                                                 Purchases and Balance Transfers:
                                                                 3.99% to 16.99%
                                                                 Cash Advances:
                                                                 Delinquency Rate:

                                                Grace Period     24 - 30 days for purchases only

                        Method of Computing the Balance for      Average Daily Balance Method (Including new purchases).

                            Annual Membership/Program Fee        $0.00

                           Minimum or Fixed Finance Charge       $2.00 minimum finance charge when interest is due

                                                  Other Fees     Cash Advance Fee: 4.00% of the transaction amount, $10.00 minimum
                                                                 Cash Equivalent Fee: 4.00% of the transaction amount, $20.00 minimum
                                                                 Late Payment Fee:
                                                                 Balance up to $100.00
                                                                 Balance from $100.00 up to $250.00
                                                                 Balance of $250.00 or more
                                                                 Overlimit Fee :
                                                                 Convenience Check Advance Fee4: 3.00% of the transaction amount, $5.00 minimum
                                                                 Overdraft Protection Advance Fee: $10.00 per occurrence

This information is accurate as of 12/2009 and is subject to change after this date. For current information, please contact Elan Financial Services at P.O. Box 6354
Fargo, ND 58125-6354 or call us at 1-800-558-3424 (TDD 1-888-352-6455) for any changes.
  Your APR will be dependent on your credit history.
  The Delinquency Rate will apply to all balances in the event the account is 15 days past due once or 5 days past due twice in any twelve (12) month period, OR may
apply if your account is over limit two times in twelve (12) consecutive months.
  The Prime Rate used to determine your APR is the highest Prime Rate published in the "Money Rates" section of the Midwest Edition of The Wall Street Journal in the
last 90 days before the date on which the billing cycle closed (in other words, the "statement date").
  Depending on your credit history, Convenience Checks may not be available to all applicants.
Notice to New York Residents: You may contact the New York State Banking Department at 1-877-226-5697 or by writing to the Research & Technical assistance
Division, 1 State St., NY, NY 10004-1417 to obtain a comparative listing of all credit card rates, fees and grace periods.
Notice to California Residents: A married applicant may apply for a separate account in his/her own name.
Notice to Married Wisconsin Residents: No provision of any marital property agreement, unilateral statement under section 766.59 of the Wisconsin statutes or court
decree under section 766.70, adversely affects the interest of the issuer, unless the issuer, prior to the time the credit is granted or an open-end credit plan is entered
into, is furnished a copy of the agreement ,decree or court order, or has actual knowledge of the adverse provisions. IF YOU ARE A MARRIED WISCONSIN RESIDENT,
Notice to Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit
reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.
APPLICANT STATEMENT: I understand that Elan Financial Services as creditor and issuer ("Issuer") will rely on the information provided here in making its credit
decision, and certify that such information is accurate and complete to the best of my knowledge. If Issuer opens an account based on this application, I will be
individually liable if this is an individual Account or individually and jointly liable if this is a joint Account (or if the Applicant is 18 or over at any time that credit is extended
under this card, both the Applicant and the Cosigner will be individually and jointly liable) for all authorized charges and for all fees referred to in the most recent
Cardmember Agreement, which may be amended from time to time. I authorize Issuer, in determining my eligibility for credit, renewal of credit, and future credit
extensions, to verify my employment and income and all other information I have provided, and obtain information about me, including my residence address, from other
creditors, credit bureaus, employers, third parties, and federal and state records, including any state motor vehicle department, and waive any rights of confidentiality I
may have in that information under applicable law. I agree that, in order to open and administer the account that may be established as a result of this application, Issuer
and the correspondent financial institution that solicited this application may share certain information about me and my ongoing account activity. By providing a
telephone number for a cellular phone or other wireless device, I am expressly consenting to receiving communications at that number, including, but not limited to,
prerecorded or artificial voice message calls, text messages, and calls made by an automatic telephone dialing system from Issuer and Issuer’s affiliates and agents. This
express consent applies to each such telephone number that I provide to Issuer now or in the future and permits such calls regardless of their purpose. These calls and
messages may incur access fees from my cellular provider. By signing, I certify that I read and understood the disclosures here and I agree to the terms of this

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