AAC CREDIT APPLICATION
Employer
Time at current employer
Spouse/Other's Employer
Time at current employer
Bank Reference
Time at current bank
Two businesses with which you have a charge account
References who work at above businesses
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This section to be filled in by AUTHORIZED PERSONNEL ONLY - before charges may be rendered:
Credit Limit Amount $
Payment Schedule $
/
weeks
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I agree to make regular payments in order to keep my account in good standing.
I agree to pay monthly balances in full each month unless arrangements have been made otherwise.
After approval, Sign Here
Approved By
Date
Please note, the fee for setting up an AAC Charge Account is $10.00.
By signing this form, you are agreeing to pay the set-up fee in addition to your account balance, including any
interest fees that may be incurred for late or missed payments. Signing this form also authorizes Alliance Animal Clinic
to perform a background check, including complete credit history in order to establish credit eligibility.
This form is to be printed and completed at the Alliance Animal Clinic
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