Personal Information

Address

Street Address *

City *

State *

Country

Postal code *

Employment Information

Current Employer Company Name *

Company Full Address *

Job Title *

Monthly Gross Income *

Upload Photo ID

Upload Proof of Income (Last Paystub or Bank Statement)

Credit Information

Social Security Number *

Do you have a checking account with ATM Visa or Mastercard Logo? *

Yes

No

Are there any unsatisfied judgements, collections, rep’s, charge offs against you? *

Yes

No

Have you been declared bankrupt in the last 7 years? *

Yes

No

Do you have credit under a different name? *

Yes

No

If yes, what name is used?

Desired Monthly Payment Date

References

First Reference

Name *

Phone *

Second Reference

Name *

Third Reference

Name *

Authorization

By signing below, I certify that I am 18 years of age and have completed the application accurately, and I understand that my signature authorizes DeAngelos Enterprises Inc. DBA DeAngelos Jewelry to establish my eligibility for credit by checking my credit history and authorize my employers, bank and/or other references 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 the best of my knowledge.

Buyers Signature *

Clear

Signature Date *

I agree that I have read and I accept the terms below. By providing my phone number and email address, I agree to receive text messages and emails from DeAngelos Jewelry regarding jewelry promotions and my credit application.