DeAngelos Jewelry Credit Application

First Name *

Last Name *

Phone Number *

Email Address *

Birth Date *

Address *

City *

State *

Zip Code *

Years at Residence *

Months at Residence *

How much downpayment? *

Social Security Number *

Do you have a Visa or Mastercard debit card? *

How did you hear about us? *

Who are you purchasing for? *

Employer *

Employer Address *

Employer Phone *

City *

State *

Zip Code *

Job Title *

Years at Employment *

Months at Employment *

Monthly Gross Income *

Full or Part-time? *

I hereby authorize the DeAngelos Enterprises, INC. DBA DeAngelos Jewelry Credit Department to make whatever credit inquiries it deems necessary in conjunction with this application. I also declare that all information is true and correct. THE FOLLOWING INFORMATION IS PROVIDED PURSUANT TO THE ARELLAS-ROBBINS RETAIL INSTALLMENT ACCOUNT FULL DISCLOSURE ACT – 1986. Credit card terms may vary among retail seller-selected terms under this retail installment account are set out as follows. FINANCE CHARGES. You will be required to pay Finance Charges on PURCHASES all extensions of credit that are not paid off in the same month. We will calculate the FINANCE CHARGE by multiplying the balance at the end of the month by 1.65% (equal to an ANNUAL PERCENTAGE RATE of 19.80% with minimum FINANCE CHARGE of $1.00 PER MONTH. NO ANNUAL FEES.

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I HAVE READ THE ABOVE INFORMATION & ACCEPT THE TERMS

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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 of perjury the foregoing is true and correct to best of my knowledge.