Layaway Application

Layaway Plan

IN-STORE - BOUTIQUE LAYAWAY ONLY

(print and bring in location)

Layaway Application

Name:

Address:

Telephone: Cell:

Dri. Lic. No: SS:

Age:

State: Zip:

Email:

(must be given or brought in)

Employment:

Address:

Telephone:

Years:

State: Zip:

Credit Range: (underline) $160. - $199. / $200. - $259. / $260. - $300.

Payment Schedule: Weekly / Bi - Weekly / Monthly Week Day:

(underline) Cash / Credit Card / Check

Mon./ Tues. / Wed. / Thurs. / Fri. / Sat. / Sun.

Must Provide 3- 5 Verifiable References:

1.Name: Tel:

2.Name: Tel:

3.Name: Tel:

4.Name: Tel:

5.Name: Tel:

Email:

Sign (Signature)

An Email Receipt of this application means that you have read the terms and polices and that you are in full agreement .

Sign: (Signature) GA LA - CAR

Print:

How did you hear about the Layaway Plan?

Print:: GA LA - CAR

*Failure to keep Scheduled Payments and or Authorized Scheduled Payments will Cancel Line of Credit