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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 trtles are optional. Applicant. if married, may apply for a separate account.
••
1. Te/I .....,.
auvu•
I"""'""~"'
DMr.
OMrs
OMiss
DMs.
Address (lo which you
want your billing ma:led)
Residence
Address
Home
Phone
Are you a Unrted D Yes
States citizen?
D No
Business
Phone
tt no,
Slate
immtgration status
Initial
Apt#
Apt#
Last Name
Crty
Crty
Social Securrty Number
Age
State
Zip Code
State
Zip Code
Number of Dependents
(excluding Applicant)
Are you a
0
Yes
permanent resident?
0
No
Howlong at
present address?
Yrs.
Mos.
D
Own
D Rent D Board D Live wrth parents
Monthly Rent or
Mortgage Payments $
Former Address (tt less than 2 years at present address)
How
long?
OccupatlOO (Former occupal!on
W
retired)
Yrs.
Mos.
Former Employe<
(W
less than 1 year
with
present employe<}
Source
of
Other
Income
MafOf Credrt Cards (VISA, MasterCard,
etc.)
Account Number
Monthly Payment
$
Other
Credrt Cards (Dept. Stores, etc.)
Account Number
Monthly Payment
$
Do
You Have A
Checking Account?
OYes DNo
Name of Bank/Financial Institution
Do
You Have A:
Name of Bank/Financial Institution
D Savings Account
D CO
D Money Market
D IRA
Relative or Persooal Refe<ence Not Living Wrth You
If
others are authorized to buy on the account
print names here and state relatkmship:
Spouse information
Address
1.
Crty
State
Zip Code
Net Income
DMonthly
(Take Horne Pay) S
OWeekly
How
long?
Yrs.
Mos.
MOTE: Alimony,child support or separate matntenance
income
need
nol
be
revealed
If
you
do
not
>Msh to have
it
constdered as a basis
tor
paying
this
obligattan
Auto Loan?
Name of Lender
O Yes D No
Prevk>us Sears Account?
D Yes D No
Account No. (Optional)
Account No. (Optional)
Crty
2.
Account Number
State
Monthly Payment
$
Is This An Interest
Paying
Or
NOW Account?
DYes DNo
Relationship
THE INFORMATION BELOW IS REQUIRED IF (1) YOUR SPOUSE IS AN AUTHORIZED BUYER, (2) YOU RESIDE IN ACOMMUNITY PROPERTY STATE (AZ, CA, 10, 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
of
Spouse
Address
I
Age
Employer
Address
How
I
Occupation
I
Social Securrty Number
I
Net Income
D Monthly
long?
Yrs.
Mos.
(Take Horne Pay)$
DWeekly
Iagree to pay Sears in accordance with the credit terms disclosed to me and to comply with all
terms of the SearsCharge Agreement. Acopy of the SearsCharge Agreement will
be
given to
me to keep when my application is approved. Sears will retain a securiJy interest where
permitted by law under the Uniform Commercial Code on all merchandise charged to the
account Sears is authorized to investigate my credit, empk>yment, and income references
x
and to report to proper persons and credit bureaus my performance of the account. Finance
charges not in e>K:ess 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 approval}. I HAVE READ AND AGREE TO THE TERMS AND CONDITIONS ON THE BACK OF THIS FORM. Iam under age 66
(71 in AZ,
NV.OK, and VA), gainfully emploved and actively workinQ at least 30 hours
pe<
week and
not
sett-employed.
Spouse's Name:
Birthdate:
I I
Accounthokktr's signature
Date:
Birthdate:
x
I I
I I
~-~•
har"" Cr-.. ---'-
~--
.. ·-
•u•;••- in CT.
NC. NH
NY or PA
916H1LHT
~
1991 Sears, Roebuck and Co.
SEE OTHER SIDE FOR IMPORTANT CREDIT TERMS.
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