Open a Preferred Customer Account at Adams & Madam of New Providence, New Jersey

Preferred Customer Accounts at Adams & Madam, New Providence, New Jersey

  We invite you to apply for an Adams & Madam Preferred Customer Account today. As an Adams & Madam Preferred Customer you will enjoy:
    · A convenient credit line
    · Flexible financing options
    · Exceptional personalized service

  Simply complete the application below and you will be on your way to enjoying the benefits of being an Adams & Madam Preferred Customer.

  If you would feel more comfortable making your application by post, you may download a printable application form by Clicking Here, or Contact Us and we will mail one to you.

  Your information will be sent to Adams & Madam via secure 128 bit SSL and will be treated with the utmost confidentiality. After submittal, an Adams & Madam representative will be in touch to finalize your application and welcome you to the elite club of Adams & Madam clients.

Preferred Customer Account Application

Notice: Please provide requested information on co-applicant if answer is "yes" to one or both of the following questions:
1. Will co-applicant sign the contract or use this account? Yes No
2. Is applicant relying on co-applicant´s income for repayment? Yes No

Name
(Applicant)

First: Initial: Last:

Name
(Co-applicant)

First: Initial: Last:

Social Security #
(Applicant)

Social Security #
(Co-applicant)

Marital Status

Married Unmarried Separated

Phone Number

Birthdate
(Applicant)

Birthdate
(Co-applicant)

# of Dependents
(Not Including Spouse)

Present Address

Street/Box/RR:
City:
State:	Zip:

Date of
Address

Employer
(Applicant)

Employer:
Position:
Employer Phone:
Date of Employment:
Monthly Take Home Pay:	$

Employer
(Co-applicant)

Employer:
Position:
Employer Phone:
Date of Employment:
Monthly Take Home Pay:	$

Other Income

Source:
Monthly take home:	$

Nearest Relative
Not living with applicant

Name:
Phone:

Alimony, child support or separate maintenance income need not be revealed if purchaser does not wish to have it considered as a basis for repaying this obligation.

Housing Info

Status:	Renting Buying Own Buying Mobile Home
Cost:	$
Value:	$
Mortgage Co./Landlord:	$
Balance:	$
Payment/Rent:	$

Auto Info

Auto 1 Make:
Auto 1 Model:
	Clear Not Clear

Auto 2 Make:
Auto 2 Model:
	Clear Not Clear

After submitting this form an Adams & Madam representative will be in touch
to finalize your Preferred Customer Account Application.

1275 Springfield Avenue, New Providence, New Jersey, USA
(866) 665-6332 - www.AdamsMadam.com - Info@AdamsMadam.com