*Full Name:
*Home Phone:
*Email:
*Birth Date:
mm/dd/yyyy
*Address:
*City: * State:
*Zip:
*Years at Home yrs months
*Do You Have A Checking account with ATM, Visa, or Mastercard Logo?

Other:
Cell Phone Work Phone
How much can you afford to put down:



*SS#:
*Employer:
* City: * State:
*Zip:
*Job Title: Full Part Time
*Years at Job
yrs
 months *Mo. Income:



*Do you have a checking account? Yes No

How did you hear about us?
 Who are you purchasing for?

You must list one reference NOT LIVING WITH YOU, with complete name, phone number, and relationship. Two more references may be required at a later date.

*Full Name:
 *
*Phone:

Please send me upcoming sales and promotions

By sending this form via email I certify that I am 18 years of age, a legal U.S. citizen and have completed the application accurately. I understand that sending this form authorizes DeAngelos Jewelry to establish my eligibility for credit by checking my credit history and authorized employer, bank, and/or other referenced to release information to DeAngelos Jewelry. If I receive credit, DeAngelos Jewelry may continue to review my eligibility by exchanging information with credit bureaus and other proper parties. I declare under penalty or perjury the foregoing is true and correct to best of my knowledge.





*Disclosure:
Consumer Credit is extended to persons whose ability to pay or credit rating is below typical standards of credit worthiness. The finance charges and annual percentage rate do not exceed those charged to persons whose credit rating has been determined and who meet generally accepted standards of credit worthiness. The down payment is as low and the period of repayment of the same duration as in consumer credit extensions to those of previously determined credit worthiness and the debtor is dealt with fairly on all conditions of the transaction including the consequences or delayed or missed payment.