فرم شماره 2 جهت ثبت نام اولیه برای درخواست كارتهاي اعتباري ویزا و مسترکارت از نوع فیزیکی و قابل شارژ
 
1.First Name * 2.MI 3.Last Name *
 
13.Cell Phone Number
(   )
14.Secondary Phone Number
(   )
15.Email Address *
 
16.Do you rent or own your home? *
17.Monthly rent/mortgage payment
$   .00
18.Employer Phone Number
(   )
19.Total household income *
$   .00 per year
 
* = Required Field
4.Social Security Number *
 
5.Date of birth(MM/DD/YYYY) *
  /   /  
6.Home Phone Number *
(   )  
7.Address (no P.O. boxes) *
 
8.City * 9.Province * 10.ZIP Code *
     
*
 
 

ترجمه فرم:

1.نام   2.نام وسط   3.نام خانوادگی   4.کد ملی    5.تاریخ تولد    6.شماره منزل   7.آدرس پستی   8.شهر   9.استان   10.کد پستی   11.نوع اشتغال   12.نام محل کار    13.شماره موبایل

14.شماره تماس دوم    15.آدرس پست الکترونیکی    16.نوع محل سکونت(مالک/مستاجر)    17.میزان اجاره ماهیانه    18.شماره محل کار    19.میزان درامد سالیانه(دلار)

قسمتهایی که با ستاره(*) مشخص شده اند بایستی به طور کامل پر شوند.
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