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YOUR TITLE
(OPTIONAL)
0
MR.
0 MRS.
NAME IN WHICH ACCOUNT IS TO BE CARRIED
FIRST NAME
LAST NAME
SEARS CANADA INC. ACCOUNT
SPOUSE'S NAME
FORIOFFllE USE
I I
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I
0
MS.
STORE NUMBER SOURCE CODE
DATE
Line of Credit
INITIALS
0
999
40
PLATES
PRESENT ADDRESS
APT. NO.
CITY
PROV.
POSTAL CODE
HOME PHONE (Area & No.)
0
OWN
I
PREVIOUS ADDRESS IF LESS THAN 2 YEARS AT PRESENT
0 RENT
MONTHLY
0 BOARD AMOUNT $__
~
MONTH
DAY
YEAR
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I
0
SINGLE
0
SEPARATED
~~RTTEHOF
[
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I
I
~NOSCI~~
I
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I
I I
I
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I
B
~~~~~~R)
0 DIVORCED
PRESENT EMPLOYER
I
EMPLOYER'S ADDRESS
I
EMPLOYER'S PHONE NO.
POSITION
GROSS
I
PREVIOUS EMPLOYER IF LESS THAN 2 YEARS AT PRESENT
MONTHLY
INCOME $
SPOUSE'S EMPLOYER
POSITION
BANK NAME
GROSS
MONTHLY
INCOME $
I
SPOUSE'S EMP. ADDRESS
I
EMPLOYER'S PHONE NO.
I
SPOUSE'SIMONTH I DAY
I
YEAR 1ISPOUSE'S1
~~RTiH
OF .
I . I . I .
~~SCI~~
.
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I
ADDRESS OF BANK
I
0 CHECKING No.
0 SAVINGS No.
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CORRESPONDENCE:
0
ENGLISH
0
FRENCH
LENGTH AT
PRESENT
ADDRESS
LENGTH AT
PREVIOUS
ADDRESS
NUMBER OF
DEPENDENT
CHILDREN:
LENGTH AT
PRESENT
EMP:
LENGTH AT
PREVIOUS
EMP:
LENGTH AT
EMP:
I
OTHER INCOME$
. SOURCE:
YRS.
YRS.
YRS.
YRS.
YRS.
NEAREST RELATIVE NOT LIVING WITH YOU (Name & Address)
I HOME PHONE (Area
&
No.) I RELATIONSHIP
CURRENT CREDIT OBLIGATIONS
MOS.
I
MOS.
I
MOS.
I
MOS.
I
MOS.
I
CREDITOR'S NAME
ACCOUNT NO.
BALANCE MONTHLY PAY'T
CREDITOR'S NAME
ACCOUNT NO.
BALANCE MONTHLY PAY'T
1.
2.
3.
4.
I certify that the information on this application iscorrect. Hthis application is accepted and account cards are issued, I agree
to
accept the terms and conditions accompanying the cards.
I the undersigned, hereby apply for an account card for myself and in the name of
who
has duly authorized me to this effect. I also apply for a credit limit up to$ _____________________
The undersigned consents to the conduct of a consumer investigation by Sears Canada Inc. and/or a consumer reporting agency and
that information concerning my account may
be
disclosed to other credit grantors or to reporting agencies.
DATE - ----- ---------
1
WANT TO BE ENROLLED IN THE SEARS CLUB. INITIAL HERE:
APPLICANT'S SIGNATURE
SPOUSE'S SIGNATURE
257
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