fax the completed form to 1.817.624.2812 |
Credit Applied for: _____ Individual _____ Joint
| 1. APPLICANT For an individual account please complete this section. | ||
| Last Name ________________________ |
First name ________________________ |
Mid. Initial/Suffix (Sr., Jr., Etc) ________________________ |
| D.O.B. (mm/dd/yy) ________________________ |
Age ________________________ |
Social Security Number ________________________ |
| Present Address | How long at this address? | Yrs ______ Mon ______ |
| Street, P.O. ________________________ |
City ________________________ |
State, Zip ________________________ |
| Home Phone w. area code ________________________ |
Work phone w. area code ________________________ |
________________________ |
| Previous Address | How long at this address? | Yrs ______ Mon ______ |
| Street, P.O. ________________________ |
City ________________________ |
State, Zip ________________________ |
| Present Employer | How long at this employer? | Yrs ______ Mon ______ |
| Company ________________________ |
Supervisor ________________________ |
Department ________________________ |
| Title/Position ________________________ |
Address ________________________ |
City, State, Zip ________________________ |
| Work phone w. area code ________________________ |
Salary ________________________ |
No. of Dependents ________________________ |
| Previous Employer | How long at this employer? | Yrs ______ Mon ______ |
| Company ________________________ |
Address ________________________ |
City, State, Zip ________________________ |
| Personal References or Relatives Not Living With You | ||
| Name (First, Last) 1.______________________ |
Address ________________________ |
Phone / Relation ___________/____________ |
| 2.______________________ |
________________________ |
___________/____________ |
| 3.______________________ |
________________________ |
___________/____________ |
| __ Renting ___ Buying ___ Own ___ Other |
Monthly Rent/Mortgage pmt. ________________________ |
|
| From ________________________ |
Address ________________________ |
Phone ________________________ |
| 2. JOINT APPLICANT or AUTHORIZED USER: Complete this section only if this is a joint application and joint applicant will be contractually liable for repayment or if applicant is relying on another party's income for repayment. | ||
| Last Name ________________________ |
First name ________________________ |
Mid. Initial/Suffix (Sr., Jr., Etc) ________________________ |
| D.O.B. (mm/dd/yy) ________________________ |
Age ________________________ |
Social Security Number ________________________ |
| Present Employer | How long at this employer? | Yrs ______ Mon ______ |
| Company ________________________ |
Supervisor ________________________ |
Department ________________________ |
| Title/Position ________________________ |
Address ________________________ |
City, State, Zip ________________________ |
| Work phone w. area code ________________________ |
Salary ________________________ |
No. of Dependents ________________________ |
| Personal References or Relatives Not Living With You | ||
| Name (First, Last) 1.______________________ |
Address ________________________ |
Phone / Relation ___________/____________ |
| 2.______________________ |
________________________ |
___________/____________ |
| 3.______________________ |
________________________ |
___________/____________ |
| Credit References | ||
| Open: Company | Address | Phone | Balance | Payment |
1.____________ |
__________________________ |
___________ |
_______ |
_______ |
2.____________ |
__________________________ |
___________ |
_______ |
_______ |
3.____________ |
__________________________ |
___________ |
_______ |
_______ |
| Paid: Company | Address | Phone | Balance | Payment |
1.____________ |
__________________________ |
___________ |
_______ |
_______ |
2.____________ |
__________________________ |
___________ |
_______ |
_______ |
3.____________ |
__________________________ |
___________ |
_______ |
_______ |
| BANK Name _____________ |
Address __________________________ |
Type Acct ___________ |
Account Number ______________ |
|
| 3. APPLICANT AND JOINT APPLICANT Please read carefully below: | ||
| FAIR CREDIT
REPORTING ACT NOTICE TO CONSUMER THIS WILL ADVISE YOU THAT YOUR RETAIL INSTALLMENT SALES CONTRACT AND BUYER'S APPLICATION FOR CREDIT WILL BE SUBMITTED TO THE FOLLOWING FINANCIAL INSTITUTION FOR PURCHASE AND CONSIDERATION AS TO WHETHER THEY MEET THEIR CREDIT REQUIREMENTS: Hopkins Furniture and Appliance, 1509 N.W. 28th St, Fort Worth, TX 76106 I have reviewed the above disclosure._______________________________ (applicant's signature) |
||
| I authorize Hopkins
Furniture and Appliance (the Creditor) to make whatever inquiries
necessary in connection with this credit application and in the course
of review or collection of any credit extended in reference on this
application. I further authorize any person or Consumer Reporting Agency
to complete and furnish to the Creditor any information that it may have
to obtain in response to such inquiries, and agree that such
information, along with this application shall remain the Creditor's
property, whether or not credit is extended. All information stated in
this application is declared to be a true representation of the facts
and made for the purpose of obtaining the credit requested.
UNDERSIGNED MAKES THE ABOVE
REPRESENTATIONS FOR THE PURPOSE OF SECURING CREDIT IN THE PURCHASE OF
MERCHANDISE AND IN A SECURITY AGREEMENT OR CHATTEL MORTGAGE EVEN DATE
HEREWITH, NO OTHER EXTENSION OF CREDIT EXISTS OR IS TO BE MADE IN
CONNECTION WITH THE DOWN PAYMENT ON SAID MERCHANDISE, AND THERE IS NO
OTHER AGREEMENT, ARRANGEMENT OR UNDERSTANDING REGARDING MY PURCHASE OF
PAYMENTS AS CONTAINED IN SAID SECURITY AGREEMENT OR CHATTEL MORTGAGE
WHICH I HAVE EXECUTED.
Applicant's Signature: ________________________________________ Date:
___________ |
||
| How may we contact you
with the results of your application? Email: __________________________ Phone __________________________ Person to contact: __________________________ |
||