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MOISTEN HERE

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 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.

15