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  • MM slash DD slash YYYY
  • Personal Reference #1

  • Personal Reference #2

  • Applicant must type their name in box below to serve as digital signature.
    By submitting this application for credit, you are authorizing Hainje’s Inc to obtain consumer credit report(s) and to verify the information herein. Please be sure that all the information stated is correct before submitting. I understand that if my credit is approved I must provide proper identification to the appropriate retail store and will be required to sign a credit agreement upon purchase. This data is for the sole purpose of determining your credit status and will be used within the Hainje’s Inc organization only, and will be processed at the Store Location for your area. Hainje’s Inc protects your information during transmission to us through an encryption process developed specifically for this purpose.