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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:
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| 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
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Layaway Policies |
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