Valero Consumer Credit Card Application
Personal Information
Full Name
*
First Name
MI
*
Last Name
Suffix
JR
SR
I
II
III
*
Date of Birth
MM
DD
YYYY
You must be at least 18 years old to apply. Please Note: Date of Birth is a required field only to verify your identity. It is not used for credit granting purposes.
*
Social Security Number
*
Primary Phone Number
Mobile
Secondary Phone Number
Mobile
*
Email Address
We may use your email address to contact you about your account. We may also use your email address to send you information about products and services you might find useful.
*
Annual Income
Whole dollars only
.00
Federal law requires that we collect income information to determine your ability to pay. Alimony, child support or separate maintenance need not be revealed if you do not wish it to be considered as a basis for repaying this obligation.
*
Home Ownership
Own/Buying
Renting
*
IF RENTING: Monthly Rent Amount $
Whole dollars only
.00
Address Information
*
Mailing Address
Address 2
*
City
*
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
WA
WI
WV
WY
*
Zip
*
Mailing address same as physical?
Yes
No
*
Physical Address
Address 2
*
City
*
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
WA
WI
WV
WY
*
Zip
Have you lived at this address more than 2 years?
Yes
No
Station Tracking Information
If you received an employee number from the station, please enter it here.
Acceptance
I have read and agree to the
terms and conditions
I have read and understand the
privacy information