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Se~rsCharge
gives
you
Buying
Power
• No annual fee
• Good nationwide
• No application fee
• Save time -
call
1-800-729-2000
Sears, Roebuck and Co. Credit Account Application
Please indicate below name in which account is to be carried. Courtesy titles are optronal. Applicant, if married, may apply for a separate account.
OMr
OMiss
OMrs
DMs.
Address
(to
which
you
want your btlhng ma:led)
Residence
Address
Home
Phone
Are
you
a
Un~ed
0 Yes
States citizen?
0 No
Business
Phone
tt
no. state
immigration status
Apt•
C11y
C11y
Social Securl1y Number
Age
State
Zip Code
State
Zip Code
Number ol Dependents
(excluding Applicant)
Are
you a
0
Yes
permanent resident?
O
No
How tong at
present address?
Yrs.
Mos.
0
Own
0 Rent
0 Board
0 Live with parents
Monthly Rent or
Mortgage Payments
$
Former Address
(tt
less
than 2 years at present address)
How
tong?
OccupatlOll (Former occupatlOll
d
retired)
Yrs
Mos.
Former Employer
(d less than 1 year with present employer}
MaJO< Credrt Cards (VISA, MasterCard, etc.)
Account Number
Monthly Payment
$
Othef
Credrt Cards (Dept. Stores. etc.)
Account Number
Monthly Payment
$
Do
You
Have~
Checking Account?
0 Yes 0 No
Name
of
Bank/F1nanc1al lnstrtubon
Do
You Have A·
Name of Bank/Flnanc1al lnstrtutK>n
0 Savings Account
D CD
0 Money Market
D IRA
Relative or Personal Reference Not Living Wrth You
If
others are authorized to buy on the account,
pnnt names here and state relat10nship:
Spouse information
Address
1.
Net Income
(Take Home Pay)
$
How
long?
0 Monthly
O Weekly
Yrs.
Mos
MOTE: Ahmony, child support or separate maintenance mcome need not
be
revealed
If
you
do
not
wish to have
rt
considered as a basis for paying this
obligation
Auto Loan?
Name ol Lender
DYes 0 No
PrevK>Us Sears
Account?
OYes ONO
Account No (OptlOllal)
Account No. (Optional)
C11y
2.
Account Number
State
Monthly Payment
$
Is This An Interest
Paying Or NOW Account?
OYes ONo
Relat100ship
THE INFORMATION BELOW IS REQUIRED IF (1) YOUR SPOUSE IS AN AUTHORIZED BUYEA, (2) YOU RESIDE IN A COMMUNITY PROPERTY STATE (AZ, 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 PAYMENT.
Name
ol
Spouse
Address
I
Age
Employer
Address
How
I
OccupatlOll
I
Social Securl1y Number
I
Net Income
0 Monthly
tong?
Yrs.
Mos.
(Take Home Pay)$
OWeekly
Iagree to pay Sears 1n accordance with the credit terms disclosed to me and
to
comply with all
terms ol the SearsCharge Agreement. Acopy ol the SearsCharge Agreement will be given to
me to keep when my applicahon is approved. Sears will retain a securitY interest where
permitted by law under the
Un~orm
Commercial Code on all merchandise charged to the
account. Sears is authorized to investigate my credit, empk:lyment, and income references
x
and to report to proper persons and credit bureaus my performance of the account. Finance
charges not in excess of those permitted by law will
be
charged on the outstanding balance
Applicant's Signature
Date
from month to month.
D
Yes. enroll me in the optional SearsCharge Credit Protection Plan from Allstate. I authorize Sears Roebuck and
Co.
to add the insurance charges to my SearsCharge Account
Statement each month as they come due (subject to aPPfoval). I HAVE READ AND AGREE TO THE TEAMS AND CONDITIONS ON THE BACK OF THIS FOAM Iam under age 66
(71
in
AZ, NV, OK. and VA), gainfully employed and actively working at least 30 hours
per
week
and
not
se"-employed
Spouse's Name:
B<rthdate:
I
I
Accountholder's signature
Date·
Birthdate:
x
I
I
I
I
~rsCha~
Credit
-~-;~
Dloft ;. ft,,.
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;ft ,.,..
NC NH NY
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916H1LHT
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t991 Sears, Roebuck and Co.
SEE OTHER SIDE FOR IMPORTANT CREDIT TEAMS.
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