Lay-Away

NAME LAY-AWAY ADDRESS CITY PHONE DATE SALESPERSON THE MERCHANDISE DESCRIBED BELOW IS BEING HELD AND I AGREE THAT THE AMOUNT DUE WILL BE PAID IN FULL AND THE , OR IT WILL BE REMERCHANDISE BE PICKED UP BY TURNED TO STOCK. CUSTOMERS SIGNATURE DESCRIPTION OF MERCHANDISE PRICE TAX TOTAL DEP. BAL. PAYMENT RECORD DATE RECEIVED BY AMOUNT PAID BALANCE DUE PRESENT RECEIPT WHEN MAKING PAYMENTS ADDITIONAL PAYMENTS RECORDED ON BACK THANK YOU MERCHANDISE IDENTIFICATION TAG NAME ADDRESS CITY STATE PHONE PICK UP DATE ZIP LAY-AWAY American LegalNet, Inc. www.FormsWorkFlow.com 2001 © American LegalNet, Inc. CONTINUED PAYMENT RECORD DATE RECEIVED BY AMOUNT PAID BALANCE DUE PICK-UP Remarks DELIVERY American LegalNet, Inc. www.FormsWorkFlow.com 2001 © American LegalNet, Inc.