Pool credit form - Effingham, IL

Name(Required)

First Last

Phone(Required)

Email(Required)

Enter Email Confirm Email

Account number(Required)

Address of swimming pool(Required)

Street Address Address Line 2 ZIP / Postal Code

Start date(Required)

The day you will start filling your pool. You will have 3 days to complete filling your pool.

Consent(Required)

I agree to the terms and conditions.

This Online E-Signature and Electronic Disclosures Agreement (“eSign Agreement”) applies to all communications, documents, disclosures ( “Communications” ) and electronic signatures related to the products, services and accounts offered or accessible through this online application process for all applicants, co-applicants and other individuals listed on the application, or any and all other application or form including beneficiaries and authorized users, if applicable.
Agreement to Conduct Transaction by Electronic means:
You agree to conduct the transactions offered through this online application process by electronic means and acknowledge that all documents, disclosures, forms and other information related to such transactions completed through this online process will result in valid and legally binding agreements. You also agree that you have adequate access to a computer or device with sufficient internet connectivity to conduct these transactions online.
Agreement to Use Electronic Signatures:
You specifically agree that any electronic signatures that you provide through this online process are valid and enforceable as your legal signature. You acknowledge that these electronic signatures will legally bind you to the terms and conditions contained in the related documents just as if you had physically signed the same documents with a pen.
Agreement to Receive Disclosures Electronically:
You agree to receive all legal and regulatory disclosures and other communications associated with any of the account applications or transactions available through this online application process through electronic means including this web based electronic interface and email.
Withdrawing your Consent:
You may withdraw your consent to this online eSign Agreement and electronic signature at any time by not clicking on the “I Agree” button on the page prior to completing the application process. If you withdraw your consent, by not clicking on the “I Agree” button before the account application process is complete, we cannot accept and process your application.

Electronic signature (your name)(Required)

First Last

Today's date(Required)

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