Jamie's Carpet Shop

First Name
Middle Name
Last Name
Date of Birth
Social Security Number
Home Phone
Mailing Address
City
State
Zip
Housing	Relative Own Rent Other
Net Monthly Income
Time At Job
Employers Phone
Relative Phone

All Fields Are Required

By submitting this application I ask the GE Capital Consumer Card Co. issue me a Mohawk Industries Inc. credit card. I am providing this information both to you and to Mohawk Carpet Corporation. I also authorize and direct you to furnish information about me (including whether this application was approved or declined) and if approved, information about my Account, to Mohawk Carpet Corporation (and its affiliates) for use in connection with the Mohawk Industries Inc .Credit Card program, including to create and update their customer records to me, to assist them in better serving me, and to provide me with notices and special promotions, catalogs and tailored offerings. I affirm that the information I have submitted is complete and truthful and that my Account will be used only for personal, family and household purposes. I authorize you to make inquiries you consider necessary (including requesting reports from consumer reporting agencies and other sources) in evaluating my application and subsequently, for purposes of reviewing, maintaining or collecting on my account. Upon my request, you will advise me of the name and address of each consumer reporting agency from which you obtained a report. I also understand that the Mohawk Industries Inc. credit card agreement (the "Agreement") will govern my Account, the terms of which are hereby incorporated into and made part of this application, and that these TERMS INCLUDE AN ARBITRATION PROVISION WHICH MAY SUBSTANTIALY LIMIT MY RIGHTS. My submission of this application represent my signature on the Agreement. I acknowledge that under the Agreement , I grant you a security interest in goods purchased on the Account, as permitted by law. I understand that there is no agreement between us until you approve my application, and that if approved, our Agreement will be deemed to have been made in Ohio. I understand that I may apply for my own Account regardless of my marital status. After credit approval and subject to the governing credit agreement, each Applicant may also use this Account and will each be liable for all credit extended under this Account to any Authorized User.