feceras.com | Credit Application

Applicant's First Name: MI: Last:	Soc. Sec. Number:
Co-Applicant First Name: MI: Last:	Co-Applicant SSN:
Applicant's Birthday: Co-Applicant's Birthday:	Phone Number:
Nearest Relative (not living with applicant):	Phone Number:
Marital status:Married Unmarried Separated (For purchase of services only, do not indicate marital status)
Number of Dependents (excl. spouse): (Check one) Rent? Own?Buying Home? Buying Mobile Home?

Present Address: City: State: ZIP: Since:
Previous Address (if less than 1 year): City: State: ZIP:
Mortgage Co./Landlord:
Original Cost: $ Current Value: $ Monthly Pmt/Rent: $ Balance Owed: $
Auto #1 (make/model): Clear? YES NO • Auto #2 (make/model): Clear? YES NO

Applicant Employer: Position: Phone:
Employed Since: Monthly Take Home Pay: $ • Other Income: $/mo. Source:
Co-Applicant Employer: Position: Phone:
Employed Since: Monthly Take Home Pay: $ • Other Income: $/mo. Source:

Disclosure for Revolving Charge Agreement
Annual Percentage Rate for Purchases	Grace Period for Repayment of Balances for Purchases	Method of Computing the Balance for Purchases	Late Payment Fee
18.00%	You have no grace period in which to repay your balance for purchases before a finance charge will be imposed.	Average Daily Balance (including new purchases).	$25.00

AMOUNT OF MINIMUM PAYMENT. The minimum payment each billing cycle will be 1/20 of the highest unpaid balance of your account, rounded to the nearest $5.00 or $25.00, whichever is greater. Periodic Rate: The periodic rate used in figuring the finance charge and the corresponding annual percentage rate is as follows: Monthly Periodic Rate: 1.500%.

SELLER SIGN HERE: Fecera's Furniture, 3030 Kutztown Road, Reading, PA 19605

BUYER(S) INITIAL HERE: INTIALS: Your initals mean that you have read and agree to the terms of our Revolving Charge Agreement and you promise to pay for all purchases on your account plus any finance charge and any other charges that may be assessed. It also means that you have compared the filled-in blanks above with the next panel, and agree that both sets of blanks are filled in the same. We will retain a purchase-money security interest in goods sold under this agreement.

YOU ACKNOWLEDGE RECEIPT OF A COPY OF OUR REVOLVING CHARGE AGREEMENT.

YOU MAY, AT ANY TIME, PAY YOUR ENTIRE BALANCE.

YOU ALSO ACKNOWLEDGE THE EXISTENCE OF THE ARBITRATION AGREEMENT CONTINED HEREIN, AND YOU SPECIFICALLY AGREE TO BE BOUND BY ITS TERMS.

BUYER'S INITIALS: DATE: