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Layaway Applicantion

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  5 Verifiable References:

1.Name:                                                Tel:

2.Name:                                                Tel:

3.Name:                                                Tel:

4.Name:                                                Tel:

5.Name:                                                Tel:

  

Email:

Email:

Email:

Email:

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 Line of Credit?

Print:: GA LA - CAR

*Failure to keep Scheduled Payments and or Authorized Scheduled Payments will Cancel Line of Credit
galacar@galacar.com Layaway Plan Layaway Application Layaway Policies Line of Credit Online Payments