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I just wanted you to know that it meant a lot to have someone who knew what he was talking about, especially with every question I had. Thanks again for the wonderful service and thanks a lot to David.

Lori , Arizona

 

For Revolving Charge Agreement only

Cash Price
Cash Down
Delivery Date
Date selector

 

Application
Will a co-signer be used on this application? Yes No
First Name - applicant Initial Last Name Cash Down Amount requested
   
Social Security Number - applicant Date of Birth - applicant Merchandise purchased
Present address - Street, box, RR - applicant City State Zip
Home phone number - applicant Cell phone number - applicant Marital Status-If purchase is of service only,
purchaser does not need to indicate marital status.
Number of dependents
(except spouse)
Married   Unmarried   Separated
1 - Rent   2 - Own Time at Residence Mortgage Company/Landlord Payment/rent
years months
Employer - applicant Position Employer phone Date of employment Monthly gross pay
Date selector
Other Income(source) Monthly gross pay
First Name - co-applicant Initial Last Name Social Security Number - co-applicant Date of birth - co-applicant Relationship to applicant
Present address - Street, box, RR - co-applicant City State Zip Home phone number - co-applicant Cell phone number - co-applicant
Employer - co-applicant Position Employer phone Date of employment Monthly gross pay
Date selector
Must Complete Image
Nearest Relative (not living with applicant) City State Area Code Phone number Relationship to applicant
Nearest Relative (not living with applicant) City State Area Code Phone number Relationship to applicant
Nearest Relative (not living with applicant) City State Area Code Phone number Relationship to applicant

Alimony, child support or separate maintenance income need not be revealed if purchaser does not wish to have it considered as a basis for repaying this obligation.

CREDIT INFORMATION. You promise that any information you give us in connection with your application or account is true and complete and understand that this information will be relied on by us in establishing your account and in extending credit under your account. We may report information we receive from you in connection with your account and information about your transactions with us to credit bureaus and others as permitted by law. If you believe we have reported incorrect information about your account to a credit bureau, you may notify us by writing to us at P.O. Box 147, St. Joseph, MO 64502-0147. Please include your account number and a description of the information that is incorrect. You further authorize us to send a text message to, or call you from any automated dialing system at any disclosed mobile number at which we reasonably believe we can contact you, for any lawful purpose, including but not limited to: (1) suspected fraud or identity theft; (2) obtaining information necessary to service your account; (3) collecting on your account; (4) notifying you as to important issues regarding your account. Telephone numbers you provide to us include both numbers you provide on this application and numbers from which you call us. You agree to pay any fee(s) or charge(s) that you may incur from incoming and outgoing calls/messages, from or to us, without reimbursement from us.

AUTHORIZATION TO INVESTIGATE CREDIT INFORMATION AND OBTAIN CREDIT REPORTS. You authorize us to investigate your credit, employment, and income records and to verify your credit references. You authorize us to obtain credit reports on you in connection with your application, in connection with any review, enhancement or collection of your account and for marketing purposes to us or to any creditor to whom we assign this account.

180 DAYS SAME AS CASH OPTION ON THIS PURCHASE
    (Must make monthly payments)

 



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