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WE SAY YES TO CREDIT!

1Choose the Type of Account Application
Type of Application (Check One):
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* Field is required.
2Individual Applicant Information
Billing Address is the same as the Mailing Address:
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2aCo-Applicant Information
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3Individual Applicant Employer Information
3aCo Applicant Employer Information
4Individual Applicant Bank Information
5Individual Applicant References
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6Previous Store Credit
Has Applicant (Co-Applicant) ever been extended credit through any Your Cost Furniture Store?:*  
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If Yes, Which Store?
7Disclaimer and Signature

1. Your signature means that you apply to Mid America Bank & Trust Company for credit pursuant to the terms of the Credit Agreement ("Agreement") attached hereto. 2. If Your application for credit is approved, Your signature means that you have read and agree to the terms of the Agreement and that all purchases on your Account are subject to the Agreement. Service charges not in excess of those permitted by law will be charged on outstanding balances. The information you furnish in this Application and on an alternate form, whether paper or electronic ("Application") is, to the best of your knowledge, complete and accurate and becomes part of the Agreement. You agree: (a) that we may obtain credit reports on you in connection with your Application and may obtain subsequent credit reports to update, renew or extend additional credit for which you apply, verify information provided on your Application, and for all other lawful uses; (b) that your information in alternate application forms may be used. 3. You consent to us and any servicer of the Account placing calls and sending text and email messages regarding the Account to any phone number or email address now or in the future associated with you, that wireless service providers may charge you for such communications, and you consent to our use of prerecorded or artificial voice messages and automatic dialing devices for such communications. You further agree that for Application and collection purposes, we may contact your employer, landlord, or third parties to verify your employment, residence, or location unless prohibited by law. 4. APPLICATIONS ELECTRONICALLY EXECUTED: If Your Application for credit is approved, Your electronic signature and/or electronic acceptance on this Application for credit evidences Your intent to enter the Agreement and You certify that You received, read, understand and agree to the terms of the Agreement. The Agreement has an Arbitration Clause with a Class Action Prohibition (Paragraph 8) that will not apply if You are protected by the Military Lending Act. You acknowledge that before signing below you received a copy of the Agreement in a form you can keep and that you read it and understood its terms.

Important Information About Opening a New Account: To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions obtain, verify and record information that identifies each person who opens an account. This means that when you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

The Open End Credit Agreement has an Arbitration Clause with a Class Action Prohibition (Parag. 7). You acknowledge that before signing below, you received a complete copy of the Agreement in a form you can keep, that you read it and understood its terms. NOTICES TO BUYER: You are requesting open end credit to finance the purchase of goods and related services from Seller. Do not sign this Application: (a) before you read it and the Open End Credit Agreement And Truth In Lending Disclosures, (b) if you did not initiate the request for credit, or (c) if you are unwilling to arbitrate disputes. You are entitled to an exact copy of the paper you sign to protect your legal rights. You have the right to pay in advance the full amount due at any time.

(By typing your name in this box, you are Legally signing this Document)
(By typing your name in this box, you are Legally signing this Document)

ASSIGNMENT BY SELLER. Seller assigns its interest in this Agreement to TIDEWATER CREDIT SERVICES, LLC, 6520 Indian River Rd., Virginia Beach, VA, 23464 ("Assignee") under the terms of a separate contract. This assignment is without recourse to Seller, except as set forth in a contract between Seller and Assignee.

8Select the Closest Store to Your Location