In-Store Credit Application

Credit Application

General Information

First Name

Last Name

Middle Initial

Doing Business As (if applicable)

Full Address

Street Number & Name, City/State & Zip

Do you own or rent?

Own

Rent

Home Phone

Cell Phone

Birthdate
*

Social Security Number

Employment Information

Occupation

Employer

Employer's Full Address

Street Number & Name, City/State & Zip

Business Phone

Co-Applicant Information

Co-Applicant Full Name

First Name, Middle Initial, Last Name

Co-Applicant Employer

Social Security Number

Co-Applicant Birthday

Credit References

Main Bank

Address

Phone

Home Loan Bank

Loan Officer

Phone

If credit is accepted, are you the only person allowed to charge on the account?

Yes

Please provide a list of approved names allowed to charge on the account. (One name per line)

You must notify us if the list changes.

Would you like to receive your invoices and statements via email?

Yes

Acknowledgement
*

This statement is submitted to obtain credit and I certify that all information herein is true and complete. I also authorize you to obtain further information concerning my credit standing.

Scruggs Lumber charge accounts are different from standard revolving charge and credit card accounts. The total amount charged in each billing period is due and payable upon receipt of your statement. You have until the 10th of each monthly following the billing period to pay your account in full without incurring finance charges. A finance charge will be applied to any unpaid balance at the rate of 1.5% per month, 18% per year (or a minimum of 0.50 for balances under $33.34) until the account is paid in full. In addition, any account which is not paid on time may be closed until the balance, including finance charges, is paid in full.

Applicant Signature

Co-Applicant Signature