Day's Charge Credit Application


* Fields in green are optional.
    1

    Please Tell Us About Yourself

      • Own Rent Live w/Parent College/School Military
    2

    Employment Information

      • Self-Employed Retired A Student Military Part-Time Full-Time
      • Yearly Monthly Biweekly Weekly
      • * Alimony, child support, separate maintenance need not be revealed if you do not choose to have it considered for repaying this obligation.
        Self-Employed Retired A Student Military Part-Time Full-Time
    3

    Please list the name and phone number of the nearest relative not living with you

    4

    Do you want a joint account?


      • Yes
    5

    Terms and Conditions

    6

    E-Sign Disclosure and Consent For Electronic Communications

      • This E-Sign Disclosure and Consent for Electronic Communications (this "E-Sign Disclosure and Consent") applies to the credit card account you are applying for online ("Account"). You agree that Day's Jewelers may provide you with your cardmember agreement ("Agreement") containing the initial disclosures for your Account, which Day's Jewelers is required to provide in writing, in an electronic format and that the Agreement will be considered "in writing". You further agree that Day's Jewelers may provide you with any other initial disclosures (the "Disclosures") in electronic format, including the US Consumer Privacy Notice, that Day's Jewelers is required to provide to you in writing before you use the credit card. The Agreement and Disclosures will be provided online once you are approved for an Account. You should print a copy of the Agreement and Disclosures for your records. You may withdraw your consent to receive the Agreement and Disclosures in electronic form by exiting this credit card application. If you withdraw your consent to receive the Agreement and Disclosures in electronic form before you complete your application for the Account, Day's Jewelers cannot accept and process your request for an Account.

        In order to access, view, and retain the Agreement and the Disclosures in electronic form, you must have:

        • an up-to-date device or devices (e.g., computer, smart phone, mobile device, tablet, etc.) suitable for connecting to the Internet;
        • an up-to-date Internet or mobile browser that Day's Jewelers supports;
        • sufficient electronic storage capacity on your device or on another data storage unit to retain the Agreement and the Disclosures and/or a printer to print the Agreement and the Disclosures;
        • software that enables you to view files in HyperText Markup Language ("HTML") and the Portable Document Format ("PDF");
        • a valid e-mail address and software to access it.

        You can obtain a paper copy of the Agreement and the Disclosures by printing it yourself when presented through this application process or by requesting that Day's Jewelers mail you a paper copy by contacting Day's Jewelers at the number on the back of your credit card.

        You acknowledge and agree that your consent to receive the Agreement and the Disclosures electronically is being provided in connection with a transaction affecting interstate commerce that is subject to the federal Electronic Signatures in Global and National Commerce Act (the "Act"), and that you and Day's Jewelers both intend that the Act apply to the fullest extent possible to validate Day's Jewelers' ability to conduct business with you by electronic means.

        By submitting this application, you hereby give Day's Jewelers your affirmative consent to provide the Agreement and Disclosures to you as described in the E-Sign Disclosure and Consent regarding the Account and that your device satisfies the hardware and software requirements specified in this E-sign Disclosure and Consent.

    7

    Sign and Agree To Terms

  1. By printing your name below, I certify that I have agreed to all the terms indicated in the Day's Charge Account Agreement & Disclosure.

    NOTICE TO CONSUMER: 1) Do not sign this application before you have read the disclosure information. 2) You are entitled to a copy of the Day's Charge Account Agreement & Disclosure.

  2. A Consumer Credit Report may be requested in connection with your application. Upon your request, you will be informed whether or not a report was requested, and the name and address of the credit reporting agency that furnished the report.

    8

    Office User Only

      • Deposit
        Sale Amount
        Salesperson
        Store