Payless Hardware | Unified Credit Application

Prototype preview: This build demonstrates the responsive website and application flow. Customer accounts, secure document storage, real email-code authentication, staff permissions, email delivery and Unicomer submission require the backend configuration described in README.md. Do not enter real identity or financial information into this preview.

Credit Application

Complete each section carefully. Fields marked * are required.

Not saved

Testing only: Use the button below to populate the form with fictional sample information and sample document images. Do not submit this test application as a real customer application.

1. PERSONAL INFORMATION

Full Name — First Name Last Name *

ID Number *

Email *

Confirm email *

Main phone *

Back Up Phone

ID Type *

Applicant type *

Upload a copy of the front of the ID *

Image or PDF. Private storage is required in production.

Upload a copy of the back of the ID *

Upload a selfie holding the ID *

2. VENDOR INFORMATION

Vendor Name *

Automatically populated by Payless Hardware & Electric Store.

Vendor e-mail address *

Value of Credit (e.g. 10000, 15000, 20000, 30000 or 40000) *

Enter any credit amount using digits only. Do not use $, decimal points, commas, or letters.

Are you making a downpayment? If YES please state average amount or type NO *

3. ADDITIONAL CUSTOMER INFORMATION

Gender *

Date of Birth (YYYY-MM-DD) *

Click “Choose date” to open the calendar. Tap the year at the top to jump directly to a year, then choose the month and day. The selected date is displayed as YYYY-MM-DD. Future dates are not allowed.

Nationality *

Upload most recent utility bill or bank statement *

The original requirements specify a recent bill. Confirm exact acceptable age in the official form.

Upload copy of authorization letter if utility bills not in your name

Optional — upload this only if the utility bill is not in your name.

Upload most recent pay slip *

No more than 1 month old, where required.

Upload a job letter *

Must confirm current employment; no more than 3 months old.

4. MARITAL STATUS

Marital Status *

Do you have any dependents? *

Enter the number of people who depend on your income for support. Verify the original form's exact explanation before production.

5. CUSTOMER ADDRESS

Home Address — Line 1 *

Home Address — Line 2

Detailed directions to the home address *

Type of Residence *

Number of years at the address *

Do you currently make rent or mortgage payments? *

6. EMPLOYMENT DETAILS

Current Occupation *

Employment status *

How long have you been in this employment? — Years *

How long have you been in this employment? — Months *

Current Employer *

Current Work Address — Line 1 *

Current Work Address — Line 2

How often do you receive your salary/wages? *

Work Phone Number *

Gross Monthly Income *

Gross income is your total income before deductions.

Net Monthly Income *

Net income is the amount you receive after deductions.

Do you currently receive any other income? *

7. REFERENCE CONTACTS

The original form includes relationship instructions for both references. Confirm the exact wording and any eligibility rules against the live form before launch.

First Reference

First Name *

Last Name *

Address Line 1 *

Address Line 2

Main Phone Number *

Reference Relationship *

Second Reference

First Name *

Last Name *

Address Line 1 *

Address Line 2

Main Phone Number *

Reference Relationship *

Applications are sent securely to Payless staff for review. Customers cannot approve applications or send them to Unicomer. This installation is still in controlled testing; do not use real customer information until all workflows and security checks are completed.

Staff Dashboard

Applications below are loaded from the Payless server database.

Pending review0

Needs correction0

Applications loaded0

Database connection: Application summaries are retrieved from the server. Full review and secure document viewing are available to authorised staff. Final email delivery is a separate staff-only step and is not enabled yet.

Search applications

Filter by status

Reference	Customer	Date received	Status
Loading applications from the server…

Connecting to the secure application list…

Your credit application Form, made simpler.

Credit Application

My Applications

Staff Dashboard