Email Form 3


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Instructions
Please fill out the form below, and click the SUBMIT button at the bottom of the screen to send us your Financing Layaway Line of Credit agreement form. Sign in the space for the service you are choosing to use. Gold financing , Line Of Credit financing (scented items) or Layaway financing. You must be 18 years or older to use the financing services listed below.

Your Name:	*
Address:	*
City:	*
State:	*
Zip:	*
Phone:	*
Your Email:	*
Member Number: Last 4 numbers of your Social Security Number:	*
Choose a payment date. And type it in the space. Example: 01/21/24:	*
My Electronic Signature agreeing to come back to Delightful Scents website for the next six (5) months on the date I typed in above and to make all my payments to Delightful Scents. Failure to come back and make all monthly payments due them, Delightful Scents will result in legal action being taken to get all monies owed them and I agree to be responsible for all fees associated with them having to take such action against me.:	*
Sign to state you are agreeing there will be a late fee of $12.00 added to your account balance for each month you fail/don't come back to this Delightful Scents website on the specified date shown above and make your monthly payments. I agree that I have a total of six (5) months to finish paying off my balance owed. No Longer. By signing my name I am agreeing to the stated terms in this section of this agreement form.:	*
Sign to state you are agreeing to a financed gold jewelry item(s). And that you are agreeing to the terms shown above for coming back to Delightful Scents website and making your payments. If you are not using this option. Do not sign.:
Sign to state you are agreeing to a Line of Credit financed scented items order. And that you are agreeing to the terms shown above for coming back to Delightful Scents website and making your payments. If you are not using this option. Do not sign.:
Sign to state you are agreeing to a layaway-financed gold jewelry item order. And that you are agreeing to the terms shown above for coming back to Delightful Scents website and making your payments. If you are not using this option. Do not sign.:
To verify the above name and address information. Email us an envelope bill picture showing your name and address information. This must be done for each individual financing option. This is simply verifying where you live and that you are who you say you are. We don't ask for your S.S. number or drivers license number. Check the box that you will email us that picture information to use our services.*
Terms for failing to make any monthly payments to Delightful Scents. My failure to make all five (5) of my monthly payments to Delightful Scents constitute a breach of my monthly payment contract agreement with them should I fail to come back to their website, delightful-scents.com and make all of my five (5) monthly payments owed to them. I agree that I the person named above shall be held responsible for paying all monetary cost incurred by Delightful Scents that's involved with them doing what ever they need to do to get back all the money I owe them. Should it be from them having to hire a lawyer and taking me to court and or hiring a tracing agency to find me. I am signing in the space provided to show/state that I agree to these terms. If I do not sign I will be denied monthly gold jewelry financing, monthly financing for a line of credit (scented items) or monthly financing for a gold jewelry layaway order. I am signing in the space provided to show that I am agreeing to these terms.:	*

(Fields marked with * are required)

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