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Sea15,
Roebuckand
Co.
CreditAccountApplication
1
91
Please indicate below name in which account is to
be
carried. Courtesy titles are optional. Applicant, ifmarried,may apply for a separate account.
O Mr.
D Mrs.
OMiss
OMs.
Address (to
wh~h
you
want your billing mailed)
Residence
Address
Home
Phone
Are you a United
States citizen?
OYes
O NO
First Name
Business
Phone
If
no. state
immigration status
Initial
Last Name
Apt.#
City
Apt.#
City
Social Security Number
Age
How long at
present address?
Yrs.
Mos
0
Own
0 Rent O Board D live with parents
Monthly Rent or
Mortgage Payments
$
Name of Landlord or
Mortgage Holder
Former Address
(it
less than 2 years at present address)
Employer
How
long?
Yrs.
Occupation
Mos.
Street Address
City
Street Address
City
Net Income
{Take Home Pay)
$
Is Account
D
Yes
State
Zip Code
State
Zip Code
Number of Dependents
(excluding Applicant)
fl.reyou a
0
Yes
permanent resident? 0 No
State
Zip Code
How
long?
Yrs.
State
Zip Code
0 Monthly
O Weekly
•w
I
Date Final
Payment Made
Mos.
Mos.
State
Relationship
ount
I
I
Monthly
imber
I
.............
.,
I
Payment
Authorized Buyer
FtrstName
lmllal
Last Name
Relationship to applicant
Authorized Buyer
First Name
Initial
last Name
Relationship to applicant
Sears is authorized to investigate my credit. employment. and income reference,and to report my performance of the account to proper persons and bureaus
x
Signature of AppUc.ant
Date
THE INFORMATION BELOW IS REQUIRED IF (1) YOUR SPOUSE IS AN AUTHORIZED BUYER, (2) YOU RESIDE IN A COMMUNITY PROPERTY STATE IAZ, CA, ID, LA, NV, NM, TX,
WA. WI). OR (3) YOU ARE RELYING ON THE INCOME OR ASSETS OF ANOTHER PERSON AS A SOURCE FOR PAYMENl:
Name ol Spouse
Employer
How
tong
Yrs
Mos
Name and Address of Bank
Name and Address of Bank
Occupation
Address
Address
Social Secunty Number
Net Income
{Take Home Pay)
S
=Savings =
=Checking=
= Savings =
=Checking =
Age
=Monthly
=Weekly
THE PERSON ON WHOSE INCOME OR ASSETS YOU ARE RELYING MUST SIGN THE AUTHORIZATION BELOW, UNLESS HE OR SHE IS AN AUTHORIZED BUYER OR YOU
RESIDE IN A COMMUNITY PROPERTY STATE (ARIZONA. CALIFORNIA, IDAHO, LOUISIANA. NEVADA, NEW MEXICO, TEXAS,WASHINGTON, WISCONSIN.)
Iauthorize Sears to mveshgate my credit. employment. and income records
Signature
Date
NAP
7186
~
NOTE Add1t1onal rnlormallon may
be
reQu11ed 10process this apphca11on You w1U
be
provided acopy of !he Sears Credit Agreement lokeepuoon approval Iagree IOpay lorancharges 101heaccount 1naccordance
.,J::a.
wilh lhe 1ermsOf the Sears Credrl Account Agreemenl which Sears will send me when my apphcat1on is approved
New
Yori( •nd Ohio residents:
See
reverse side.
)>
Finance charges not in excess of those permitted by law will be charged on the outstanding balance from month to month
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