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Financing Application Form
 
Type of Application (Check One):
Individual Joint

(Individual Account, complete sections 1 & 3 / Joint Account complete entire application)
1. APPLICANT : Incomplete form may result in decline of your credit application.
Please Print Clearly.
*Applicant's First Name :

(First Name)
*Applicant's Middle Name :

(Middle Name)
*Applicant's Last Name :

(Last Name)
*Social Security # :
*Date of Birth :
*Street Address :
*City :
*State :
*Zip Code:
    Time at Residence : YEARS : MONTHS:
*Home Phone # :
*Cell Phone # :
*Email Address :
*Employer :
*Position :

(Job Title, If Military, Rank)
*How Long : YEARS : MONTHS:
Work Phone # :
*Income :
 $

(Alimony, child support or other separate maintenance income does not need to be disclosed If you do not wish to have it considered as a basis for paying this obligation.)
*Applicant : Rents :  Owns/Buying :
*Monthly Payment : $
*Mortgage/Landlord :
*Mortgage/Landlord Phone # :
Nearest Relative Not living with you :

(Relationship Name, Address, City, State, Zip, Phone)
2. CO-APPLICANT: Please complete for Joint Account. Incomplete form may result in decline of your credit application.
*Applicant's First Name :

(First Name)
*Applicant's Middle Name :

(Middle Name)
*Applicant's Last Name :

(Last Name)
*Social Security # :
*Date of Birth :
*Street Address :
*City :
*State :
*Zip Code:
  Time at Residence : YEARS : MONTHS :
*Home Phone # :
*Cell Phone # :
*Email Address :
*Employer :
*Position :

(Job Title, If Military, Rank)
*How Long : YEARS : MONTHS:
*Work Phone # :
*Income :
 $

(Alimony, child support or other separate maintenance income does not need to be disclosed If you do not wish to have it considered as a basis for paying this obligation.)
*Applicant : Rents :  Owns/Buying :
*Monthly Payment : $
*Mortgage/Landlord :
*Mortgage/Landlord Phone # :
Nearest Relative Not living with you :

(Relationship Name, Address, City, State, Zip, Phone)
3. APPLICANT & CO-APPLICANT (if applicable): Please sign and date the credit application.
* Field is required.
Has Applicant (Co-Applicant) ever declared Bankruptcy? *
 Yes :  No :
Has Applicant (Co-Applicant) ever been extended credit through any Badcock Store?* Yes :  No :
If Yes, Which Store ? (City & state )*

All of the information stated on this application is, to the best of your knowledge, complete and accurate. You agree that we may obtain a credit bureau report on you and we may verify any of the information provided on this application, including residency. By completing and signing this application, you request an account be established which will allow you to make purchases under this account. By signing, you agree to the terms and conditions of both the Credit Application and the Badcock's Economy Furniture Store, Inc. Easy Purchase Plan Agreement Form BE22FL REV 07-10 (which includes an arbitration provision), which form is part of this combined Credit Application and the Badcock's Economy Furniture Store, Inc. Easy Purchase Plan Agreement, and is incorporated herein by reference. You understand that if approved, you agree to the terms of the account and that you have read and received a copy of your agreement before making any purchases on this account. The terms are attached. If this is a joint credit application, you understand that each applicant has the right to use the account and both parties shall be jointly and severally liable for all purchases made under the account by any joint applicant. NOTICE TO BUYER: (a) Do not sign this before you read it or if it contains any blank spaces. (b) You are entitled to an exact copy of the paper you sign. (c) You have the right to pay in advance the full amount due. ANY HOLDER OF THIS CONSUMER CREDIT CONTRACT IS SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED PURSUANT HERETO OR WITH THE PROCEEDS HEREOF. RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR HEREUNDER. YOU HEREBY ACKNOWLEDGE RECEIPT OF A FULLY EXECUTED AND COMPLETE COPY OF THIS CONTRACT.
Driver's License #* Driver's License #*
Signature of Applicant* : Signature of CO-Applicant*:

(By typing your name in this box, you are Legally signing this Document)

(By typing your name in this box, you are Legally signing this Document)
Credit Application Additional References : Date*:
Applicant Name:

Personal Reference (Name, Street, City, State, Zip, Phone #)



Personal Reference (Name, Street, City, State, Zip, Phone #)
Co-Applicant Name:

Personal Reference (Name, Street, City, State, Zip, Phone #)



Personal Reference (Name, Street, City, State, Zip, Phone #)
Send to Store*:
Please Print this form out for your own records*:
By clicking on the submit button, you have read, understood, and accepted the terms in the Credit Agreement. *
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Information Accuracy - We have taken great care to provide you with information that is accurate and useful. Please notify us if you find an error, and we will do our best to correct it. We ask that you contact us directly and visit our stores to confirm information about pricing, color, features, dimensions, availability and special order lead times.
OUR LOCATIONS
Badcock - Lake Park
1409 10th Street
Lake Park, FL 33403
Tel: 561-848-6200
 		 Badcock - West Palm Beach
4423 Cherry Road
West Palm Beach, FL 33409
Tel: 561-684-1604
 		 Badcock - Lake Worth
1630 S. Dixie Highway
Lake Worth, FL 33460
Tel: 561-588-2717
 		 Badcock - Delray Beach
2400 N. Federal Hwy.
Delray Beach, FL 33483
Tel: 561-243-8393
 		 Badcock - Pompano
3051 N. Powerline Road
Pompano Beach, FL 33069
Tel: 954-977-4884
 		 Badcock - Ft. Lauderdale
770 W. Sunrise Blvd
Ft. Lauderdale, FL 33311
Tel: 954-462-6577
 
Badcock - Plantation
3821 W. Broward Blvd.
Plantation, FL 33312
Tel: 954-791-8400		 Badcock - Hollywood
2147 Pembroke Road
Hollywood, FL 33020
Tel: 954-921-2884		 Badcock - Miami Gardens
19450 NW 27th Ave
Miami Gardens, FL 33056
Tel: 305-625-8234		 Badcock - Florida City
33493 S. Dixie Hwy.
Florida City, FL 33034
Tel: 305-245-0611		 Badcock - Cutler Bay
19600 S. Dixie Highway
Cutler Bay, FL  33157
Tel: 305-232-0359		  
 

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