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1Choose the Type of Account Application
Type of Application (Check One):
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* Field is required.
2Individual Applicant Information
Billing Address is the same as the Mailing Address:
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2aCo-Applicant Information
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3Individual Applicant Employer Information
3aCo Applicant Employer Information
4Individual Applicant Bank Information
5Individual Applicant References
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6Previous Store Credit
Has Applicant (Co-Applicant) ever been extended credit through any Chertok's Furniture & Mattress - Coatesville, PA Store?');?>:*  
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If Yes, Which Store?
7Disclaimer and Signature
(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)
I HEREBY ACKNOWLEDGE that I am over the age of eighteen (18) years, and that all of the information set forth in this credit statement is true, accurate and a full and complete disclosure thereof. I HEREBY authorize the Merchant and/or its assignees to make all inquiries necessary to verify the accuracy of the statements made in the application and to determine any creditworthiness by obtaining consumer reports from consumer reporting agencies and information from others including creditors, financial institution,references,employers,landlords and others identified in the application, (including any employee or agent of any of them). IN THE EVENT that credit is extended:(1) I hereby authorize any holder or assignee to obtain credit reports, in connection with the extension of credit, for the purpose of reviewing the account, taking collection action on the account, or for other legitimate purposes associated with the account; and (2) I acknowledge, as part of Merchant's information collection process, Merchant may detect additional bank accounts belonging to you. I FURTHER AUTHORIZE the Merchant and/or its assignees any attorney, debt collector or collection agency communicating any and all information concerning this application or debt to any credit reporting agency or other creditor.I FURTHER ACKNOWLEDGE AND AGREE, that i will notify the creditor or prospective creditor in writing of any change in my name, address or employment within a reasonable time thereafter. I agree that Merchant and its assignees may contact me in writing, by e-mail, or using prerecorded/ artificial voice messages, text messages, and automatic telephone dialing systems, as law allows, I also agree that Merchant and it assignees may contact me in these and other ways at any address or telephone number I provide, even if the telephone number is a cell phone number or the contact results in change to me. pursuant to the Fair Credit Reporting Act, I acknowledge and agree that my credit application may be submitted to any finance company or bank for consideration for the extension of credit.
 
8Select the Closest Store to Your Location