Application
For WI residents, if you are applying for individual credit or joint credit with someone who is not your spouse, combine your and your spouse's financial information on the application form.
Name (First-Middle-Last)
D.O.B. (MM/DD/YYYY)
S.S.# (123-45-6789)
Home Phone # (555-555-5555)
Mailing Address
Time at Address
Time At Job
Cell/Other Contact Phone
Housing Information
Physical Address (if different from above)
Monthly Net Income From All Sources
$
Employer's Phone #
Relative's Phone #

Statement of Acceptance


By checking "I Accept" on this application, I ask that GE Money Bank ("you") 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 is approved or declined) and, if it is approved, information about my Account, to Mohawk Carpet Corporation (and its affiliates) for use in connection with the Mohawk Industries Inc. Cred Card program, including to create and update their customer records for me, to assist them in better serving me, and to prvide me with notices of 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 my account. Upon my request, you will adise 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 by reference into and made a part of this application, and that these TERMS INCLUDE AN ARBITRATION PROVISION WHICH MAY SUBSTANTIALLY LIMIT MY RIGHTS. By checking the "I Accept" box, it represents 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 Utah. 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 use this Account and will each be liable for all credit extended under this Account to any Applicant or Authorized User. I have read and agree to the Privacy Policy.
Federal law requires us to obtain, verify, and record information that identifies you when you open an account. We will use your name, address, date of birth, and other information for this purpose.


PROTECT YOUR CREDIT CARD ACCOUNT WITH DEBT SECURITY - (optional)

By checking the "YES" box, I am signing to purchase Debt Security. I acknowledge that I do not need to purchase Debt Security to get credit. I have read the disclusures set forth within (if the associate solicited this application for Debt Security) and I have read the disclosures that are set forth in the Debt Security Summary. I agree that you may bill my Account a fee each month of $0.99 per $100 of the average daily balance of my Account as provided in the terms of the Debt Security agreement. I may cancel at any time.