SSHOME PERSONAL CREDIT APPLICATION

PERSONAL CREDIT APPLICATION
1315 East Main Street / P.O. Box 706
Magnolia, AR 71754-0706
870-234-6060
accounting@sshomecenter.com
*This is NOT a revolving credit account. All bills are due in full on the 10th. No partial payments. See the terms below.
Date

MonthDayYear
Date
Full Legal Name
SS#
DL #
Date of Birth

MonthDayYear
Date
Email
example@example.com
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile
Is this phone associated with your ACE REWARDS account?Yes No
If not, what phone number was your ACE REWARDS connected to? Ace Rewards Phone Number
Would you like to transfer your ACE REWARDS to this account?Yes No
(If you do not have ACE REWARDS, one will be assigned to you via the phone number provided so you do not miss coupons and sales events.)
Employer
How long?
Salary
Supervisor
Employer Phone Number
Spouse (if joint acct.)
Spouse SS#
Spouse Employer
How long?
Spouse Salary
Spouse Supervisor
Spouse Employer Phone Number
Credit References:
Credit Reference 1.) Name
Credit Reference 1.) Phone
Credit Reference 2.) Name
Credit Reference 2.) Phone
Credit Reference 3.) Name
Credit Reference 3.) Phone
Name of Bank
Bank Contact
Persons authorized to charge to this account:
1.
2.
3.
4.
5.
6.
Purpose of this account:

New HomeRemodelAdditionalMonthly SuppliesResaleOther
Monthly Credit Limit Requested: $
Our Terms:

All account balances are due in full by the 10th day of the month following the date of your statement. A FINANCE CHARGE computed by a "periodic rate" up to the legal limit, currently 1.4166% per month (Equivalent to an ANNUAL PERCENTAGE RATE of 17%) will be charged on any portion of the account balance appearing on your monthly statement that is not paid or otherwise credited to your account on or before the due date. Interest rates may fluctuate. In addition, a LATE CHARGE of $5 will be applied to past-due balances at the time of the statement.

Credit or debit card payments made AFTER THE TIME OF PURCHASE with amounts over $500 will be assessed with a TRANSACTION FEE of 2%.

We email all statements to the provided email address on this application. There is NO CHARGE for emailed statements and invoices.

All information in this application is true, accurate, and complete. I authorize S&S Home Center to investigate all information about my credit history with previous and current creditors, not limited to those listed within the application. This authorization shall remain on file and serve as an ongoing authorization for S&S Home Center to procure credit reports at any time during the relationship. I have read and understand the terms of this agreement.
Applicant's Signature*

Clear
Date*

MonthDayYear
Date
Co Applicant's Signature

Clear
Date

MonthDayYear
Date
S&S Home Center Credit Authorization Form

First Name: First Name Middle Initial: Middle Initial Last Name: Last Name
Address: Street Address
City: City State: State Zip Code:   Zip Code
DOB: DOB SSN:   123-45-6789
Phone: Phone Number Email: Email

You understand that by signing below you are providing "written instructions" to S&S Home Center under the Fair Credit Reporting Act, authorizing S&S Home Center to obtain information from your personal credit profile or other information from Equifax and/or TransUnion and/or Experian. You authorize S&S Home Center to obtain such information solely to conduct a pre-qualification for credit or to reverify the score should you request a credit increase in the future.

Date: Date
Name:   Full Name
Signature:   Signature
Drivers License*

Cancelof
Should be Empty: