Manly's Furniture & Appliances
2011 S. Mobberly
Longview, TX 75602
Phone: (903) 758-0545
Fax: (903) 758-4394
Credit Application

Fill out the form below with your information. When you are finished select the SUBMIT button at the bottom of the form and send it to us electronically. You may also print the completed form to be mailed, faxed or brought into the store.

Primary Applicant


First MI Last First MI Last
SS Number SS Number
Date of Birth Date of Birth
Street Address Street Address
City City
State State
Zip Zip
E-mail Address E-mail Address
Home Phone Number Home Phone Number
Cell Phone Number Cell Phone Number
Work Phone Number Work Phone Number

Employer Employer
Street Address Street Address
City City
State State
Zip Zip
Employment Length Employment Length
Salary Salary
Other Income Other Income

Amount of Credit Requested
How would you like to be contacted about this application?
Red text indicates required field for application processing. Do not leave blank.

By submitting, you agree to the following: Everything you have stated in this application is correct, accurate and to the best of your knowledge. You authorize Manly's Furniture & Appliances to obtain credit reports in connection with this application for credit and for any update, renewal, extension or related collection of the credit received. If you request, We will notify you the name and address of any credit bureau from which we received a credit report on you. You agree to notify us of any change in you name, address or employment within a reasonable period of time. Alimony, child support or separate maintenance income need not be revealed if you so choose not to have it considered.