SINGLE CREDIT APPLICATION

Please complete the form below:

PERSONAL INFORMATION
Email Address	*		Marital Status	*	SINGLE MARRIED
First Name	*		Last Name	*
SSN	*		DOB	*
Phone Number	*		ID Number	*
			State	*	- - Choose One - - AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NH NJ NL NM NS NT NU NV NY OH OK ON OR PA PE PR QC RI SC SD SK TN TX UT VA VT WA WI WV WY YT
			Expiration	*
			State ID	*
ADDRESS HISTORY
Address	*
City	*		State	*	- - Choose One - - AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NH NJ NL NM NS NT NU NV NY OH OK ON OR PA PE PR QC RI SC SD SK TN TX UT VA VT WA WI WV WY YT
Zip	*		Rent/Own	*	Rent Own Other
Since	*		Monthly Payment	*
			EMPLOYMENT INFORMATION
			Employer	*
Position			Employer Phone	*
Monthly Net Income	*		Since	*
Other Income/Source
			Comments
Best Method of Contact	*	PHONE EMAIL TEXT	Security Code	*
			Disclosure		THIS APPLICATION IS BEING SUBMITTED TO OBTAIN A LOAN AND I CERTIFY THAT ALL INFORMATION I HAVE PROVIDED IS TRUE AND CORRECT. BY APPLYING FOR THIS LOAN FROM HOUSEHOLD FURNITURE OR ITS ASSOCIATED LENDERS, I AUTHORIZE HOUSEHOLD FURNITURE CO., ITS REPRESENTATIVES, AGENTS AND ASSIGNEES, TO VERIFY THE INFORMATION AND THE CREDIT REFERENCES I HAVE PROVIDED, AND TO OBTAIN CREDIT REPORTS AND OTHER CREDIT INFORMATION BOTH NOW AND IN THE FUTURE FOR ANY LEGITIMATE PURPOSE ASSOCIATED WITH THIS APPLICATION OR THE LOAN, INCLUDING, BUT NOT LIMITED TO, REVIEWING, RENEWING, OR COLLECTING ON THE LOAN. I UNDERSTAND THAT IF THIS APPLICATION IS APPROVED, THE TERMS AND CONDITIONS APPLICABLE TO THE LOAN WILL BE SET FORTH IN THE PROMISSORY NOTE AND FEDERAL TRUTH-IN-LENDING DISCLOSURES, WHICH I AGREE TO READ BEFORE SIGNING. I UNDERSTAND THAT I MUST UPDATE MY CREDIT INFORMATION AT YOUR REQUEST IF MY FINANCIAL CONDITION CHANGES. I UNDERSTAND THAT HOUSEHOLD FURNITURE WILL RETAIN THIS APPLICATION WHETHER OR NOT IT IS APPROVED.