Brashears Furniture Credit Application
All information is confidential. If you have any questions regarding our
credit form or policies, please call 800.557.4302.

 

First Name

 

Middle, Last Name

   Social Security #
   Date of Birth (DD/MM/YY)
Street Address
 City
 State
Zip Code
   Home Phone
 Time at Address (Yrs)
 Email Address (required)
         

Financal Information
....................................................................................................................
Employer
   Job Title
  How Long?
Work Phone
  Salary (Per Month)

Other Income

 Source of Other Income
 
  I have a Checking
Checking Acct(s)
Savings Acct(s)		 Currently
Renting
Own/Buying		   Monthly rent or Mortgage


Home value (if owner)
   Mortgage bal. (if owner)
 
Co-Applicant
....................................................................................................................
First Name
   Middle, Last Name
   Social Security #
   Date of Birth (DD/MM/YY)
Street Address
 City
 State
Zip Code
   Home Phone
 Employer
Job Title
  How Long?
  Work Phone
  Salary (Per Month)
Nearest living relative not living with you: (Relationship, Name, Address, City, State, Zip, Phone