Gary's Carpet makes it easy to get the flooring you want today.

In addition to accepting all major credit cards, we offer special financing. You can apply right here online and either submit the form so we can process it, fill it out, print it and bring it in with you, or print it out and fax it to us at 281-496-5416.

Our Credit Application is below:

Pro Flooring Retailer #	________________________	Amount of Purchase $	________________________
Authorization Number	________________________	Customer Account #	________________________

Gary's Carpet Credit Card Account Application

Click here for Credit Agreement and Billing Rights

It may be necessary for a Gary's Carpet representative to contact you regarding this application. How would you prefer to be contacted?
e-mail	fax	day phone	evening phone	mail

Check Account Choice

Individual

Joint

Name:

Date of Birth:

Address:

Apt. #:

City:

State:

Zip:

Day Phone No.

Evening Phone No.

Fax No.

E-mail

Own Rent

How Long at this Address:

Years :

Months:

Landlord or Mortgagee:

Mort. or Rent Monthly $

Previous Address:

City:

Zip:

How Long: yrs.

Your Employer:

How Long There: yrs.

Your Position:

Phone #:

Soc. Sec. #:

Your Annual Salary $:

Other Income:

Previous Employer (if retired or less than 3 years in present job)

Name and Address of nearest relative not living with you

1. If you reside in Wisconsin and are married, you must provide your spouse's name and address
unless this is a joint application with your spouse.

Co-Applicant:

Date of Birth:

Soc.Sec. #

Address:

How Long: yrs.

Phone #:

Employer

How Long:

Phone #:

Employer's Address:

*Other Income Sources:

*Alimony, child support, or separate maintenance income need not

be revealed if the applicant does not desire to have it considered in determining creditworthiness.

You Acknowledge receipt of a copy of the credit card account agreement.
Retail installment credit agreement.

You acknowledge the existence of the arbitration agreement contained in the credit card account agreement and retail installment credit agreement and you specifically agree to be bound by its terms.

By submitting electronically, you agree to all terms contained in agreements above.
Please initial to represent your signature.

To submit via fax, print page, complete fields and fax to 281-496-5416

Your signature represents compliance with all agreements and instructions.

Applicant's Signature:_________________________________ Date:_______________________

Co-Applicant's Signature______________________________ Date:_______________________

Bottom Acknowledgement section is for printing purposes only.

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