Customer Instalment Payment Form
Please provide your details and payment instalment information below.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Order Description
What products are you purchasing in instalment?
Total Payment Amount (BDS)
*
Instalment Frequency
*
Please Select
Weekly
Bi-Weekly
Monthly
Quarterly
Other
First Instalment Due Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Notes (optional)
TERMS AND CONDITIONS
A
DEPOSIT OF TWENTY PERCENT (20%)
IS REQUIRED TO START A LAYAWAY. Goods are Not Reserved for a Client until the payment of the Deposit.
DEPOSITS ARE
NON-REFUNDABLE
NO INTEREST IS CHARGED ON LAYAWAY PAYMENTS
Layaway Term
Layaway Term is sixty days (or two months) from the start date. The item(s) must be paid for in full within this period.
Payment Schedule
Upon submission of this form, a weekly payment schedule will be sent to you to assist you in recording payments.
Missed Payments
A fourteen day grace period applies to missed payments. If no payment is made after fourteen days, the layaway plan
may be cancelled and your deposit (ie. 20% deposit) may be lost
.
Early Payments -
Payments may be made earlier than scheduled.
Cancellation
Layaway Deposits (ie. 20% deposit) are NON-REFUNDABLE. Payments over and above the deposit may be refunded.
Item Pickup
Item(s) must be collected/ picked up within 5 days from the date of final payment. Storage fees at the rate of $20.00 per day will be charged on late collections.
Ownership
Item(s) remain property of the store until fully paid.
Exclusions
Layaway is not available on sale or special order item(s) unless otherwise agreed/approved.
Terms and Conditions
*
Signature
*
Submit Plan Request
Submit Plan Request
Should be Empty: