Name:
Name of Co-Applicant (if joint account):
Relationship of Co-Applicant to Applicant:
Address:
City: State: Zip:
Home Phone: ()
Business Phone: ()
Email Address:
Social Security Number:
Optional: If you do not wish to provide a SS# on this
form, you may send in the application anyway. A Dillard's representative
will call you and you can provide your SS# at that
time.
Date of Birth:
Optional: If you do not wish to provide a Date of Birth on this
form, you may send in the application anyway. A Dillard's representative
will call you and you can provide your Date of Birth at that
time.
Employer:
Credit Reference (check one):
Visa
MasterCard
American Express
Diners Club/Carte Blanche
Discover
Account Number:
Optional: If you do not wish to provide account references on this form, you may send in the application anyway. A Dillard's representative will call you and you can provide your account references at that time.
Expiration date: Month Year
For the purpose of securing credit from you, I certify that the above information is true and complete to the best of my knowledge. I further certify that
I have attained The Age of Majority.
I authorize you to check my credit and employment history and to provide and/or obtain information about credit experiences with me.
By submitting this completed form, I acknowledge that I have read and understand the disclosures. I agree that Dillard's may investigate my credit record and that, if an account is opened, they may furnish information regarding this account to credit repo
rting agencies and others who may properly request such information.
I (we) agree that if I (we) use or permit another person to use my (our) Dillard's credit card, I (we) will be bound by the terms of the Credit Card Agreement mailed with the card.
The information below concerning the costs of the card described in this application is accurate as of August, 1996. It may have changed since then. To find out what may have changed, write to us at: Dillard National Bank, P.O. Box 52005, Phoenix, AZ 8507
2, Attention: Credit Manager.
Finance Charge Computation - Monthly Rate
The following information applies to residents of all states in the U.S.
Periodic Rate |
1.65% |
Annual Percentage Rate |
19.8% |
Method for Computing the Balance for
Purchases |
Average Daily Balance (Including new purchases) |
Portion of Average Daily Balance to Which
Applied |
Entire |
Minimum Monthly Finance Charge |
$0.50 |
Grace Period for Repayment of Balances
for
Purchases |
Not Less than 25 Days |
Late Fee |
$20.00 |