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customer services  |  Borsheim's revolving charge

Our revolving account allows you to make minimum monthly payments against your balance over 36 months at an interest rate of 18% APR. See legal agreement for details on how your monthly payment will be calculated. A minimum down payment of 10% will be required on your first purchase based on your credit application.

Please complete the following application, print and sign it. Send or fax it to:
Borsheim's
Credit Approval Department
120 Regency Parkway
Omaha, Nebraska 68114
Fax: 402-391-2762
please tell us about yourself (All information is kept in strict confidence with Borsheim's Jewelry Company.)
Are you currently working with a Borsheim's associate? Yes No If Yes, who?
  * Required Fields
First Name* M.I.*
Last Name* (You must be a U.S. resident to apply.)
Address* (No P.O. Boxes please)
 
City*
State*
Zip*
Lived There* Years
Day Phone*
Email Address*
Driver's Licence #*
Date of Birth*
SSN*
Have you filed for bankruptcy? Yes No If Yes, what year?

previous address (if less than two years at present)
Address
 
City
State
Zip
Lived There Years

job information (If retired, note previous employer. If self-employed, note nature of business.)
Employer Name*
Position*
Address*
 
City*
State*
Zip*
Worked There* Years
Work Phone*
Gross Annual Income*

previous employer (if less than two years at present)
Employer
Position
Address
 
City
State
Zip
Worked There Years
Work Phone
Gross Annual Income

second cardholder (optional)
First Name M.I.
Last Name
Address
 
City
State
Zip
Lived There Years
Day Phone
Email Address
Driver's Licence #
Date of Birth
SSN
Have you filed for bankruptcy? Yes No If Yes, what year?

second cardholder job information (If retired, note previous employer. If self-employed, note nature of business.)
Employer
Position
Address
 
City
State
Zip
Worked There Years
Work Phone
Gross Annual Income

I have read the legal agreement and agree to all the conditions stated.

I have read and understand the terms and conditions of this Borsheim's Jewelry Co., Inc. (Borsheim's) Credit Application and Borsheim's Revolving Charge Agreement and all applicable disclosures required by Federal law. Borsheim's is authorized to investigate my credit, employment, and income references and to report to credit bureaus my performance of the account. By signing this Application I agree to be bound by its terms and conditions of the Borsheim's Revolving Charge Agreement and hereby acknowledge receipt of said Application and Agreement. No oral representations altering or amending the Revolving Charge Agreement have been made to me.

Security Agreement
I hereby grant to Borsheim's Jewelry Company, Inc., a security interest under the Uniform Commercial Code as adopted by Nebraska in all merchandise charged to my account.

Balance Transfer Option
If checked and initial here __________
I authorize the transfer of any existing balance(s) owed by me to Borsheim's to my revolving account and agree that the terms and conditions of the Borsheim's Revolving Charge Agreement shall apply to these balances upon transfer, except that interest computed as specified in FINANCE CHARGE section of the Agreement shall apply from the date of transfer of any prior balances.
Cardholder's Signature (1) Date
Cardholder's Signature (2) Date

*As used in this Agreement the terms "I", "me", "my", and "mine" refer to the cardholder and if two or more cardholders are authorized to charge on my account, all references to these terms are plural.

ANY HOLDER OF THIS CONSUMER CREDIT CONTRACT IS SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF THE GOODS OR SERVICES OBTAINED PURSUANT HERETO OR WITH THE PROCEEDS HEREOF. RECOVERY HEREUNDER BY DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR HEREUNDER.