INDIVIDUAL/JOINT/DBA

 

APPLICATION FOR CREDIT

102 West Cortland Street
PO Box 117

Groton, NY 13073
607-898-5851 or 277-3977
FAX: 607-898-3725
 

DATE:

 

 

    

NAME OF ACCOUNT IF DBA

        

 

  

 

  

 

NAME OF INDIVIDUAL

  

SOC. SEC. NO.

  

DATE OF BIRTH

 

  

 

  

 

ADDRESS

  

YEARS

  

RES. PHONE

 

  

 

  

 

FORMER ADDRESS

  

YEARS

  

BUS. PHONE

 

  

 

  

 

PRESENT EMPLOYER

POSITION

  

YEARS

  

INCOME

ADDITIONAL INCOME:

RENT

OWN

 (check one)

REAL ESTATE IN NAME OF

MORTGAGE HELD BY

 

BANK REFERENCE:

 

CREDIT REFERENCES:

1.

 

2.

 

CO-APPLICANT
 

 

  

 

  

 

NAME OF INDIVIDUAL

  

SOC. SEC. NO.

  

DATE OF BIRTH

 

  

 

  

 

ADDRESS

  

YEARS

  

RES. PHONE

 

  

 

  

 

FORMER ADDRESS

  

YEARS

  

BUS. PHONE

 

  

 

  

 

PRESENT EMPLOYER

POSITION

  

YEARS

  

INCOME

ADDITIONAL INCOME:

RENT

OWN

 (check one)

REAL ESTATE IN NAME OF

MORTGAGE HELD BY

 

BANK REFERENCE:

 

CREDIT REFERENCES:

1.

 

2.

 

We agree, that in the event that credit is extended to us, to pay all invoices when due according to Baker-Miller terms: Cash 15th of month after receipt of merchandise. MASTER CHARGE, VISA, DISCOVER, AMERICAN EXPRESS are the only installment plans offered. Past due accounts are subject to a finance charge of 2% per month up to $500.00, (APR 24% per annum), 1 1/2% per month in excess of $500.00, (APR 18% per annum), minimum finance charge $.50 per month. In the event Baker-Miller has to institute collection proceedings to collect payment of this account, we agree to pay any and all costs of collection plus reasonable attorney's fees which cannot be more than 20% of the amount we owe.

We hereby authorize Baker-Miller to conduct credit investigations at their discretion.
 
 

 
 

APPLICANT'S SIGNATURE

DATE      

 

 
 

CO-APPLICANT'S SIGNATURE

DATE      


The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of sex or marital status. The Federal Agency which administers compliance with this law concerning this store is the Federal Trade Commission, Washington, D.C. 20580.