Lay-Bye - Clearance Warehouse

Lay-By Form

Lay-Bye Contract
Name*
First Last
Work Phone*
Home Phone*
Fax Number
Cellphone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Identity Number (Compulsory)
ID Number*
ID Document*
Spouse/Partner*
Spouse/Partner Name*
First Last
Spouse/Partner Work Phone*
Spouse/Partner Home Phone*
Spouse/Partner Fax Number
Spouse/Partner Cellphone*
Terms & Conditions*
- I hereby acknowledge that I have read the Terms and Conditions. I understand and agree to the content herein.
Client Signature*
Date*
Date Format: MM slash DD slash YYYY
Initial*
Consent*
I {name} agree to make payments on the specified dates and to the agree amounts stated on the payment schedule below to Clearance Warehouse Africa. I understand the consequences that will be brought against me if the contract is violated. The penalties will be 15% off the full purchase price paid to date. I agree to pay the above mention fees to Clearance Warehouse Africa.
Payment Schedule Plan
The full purchase amount owed to Clearance Warehouse Africa R*
Description of Goods*
Payment Date*
Payment Amount R*
Balance R*
Payment Date*
Payment Amount R*
Balance R*
Payment Date*
Payment Amount R*
Balance R*
Payment Date*
Payment Amount R*
Balance R*
Payment Date*
Payment Amount R*
Balance R*
Consent*
I agree that the above schedule of payments is an acceptable resolution to help retire my debt with Clearance Warehouse Africa, and I remain current with this payment plan until amount is paid in full.
Client Signature*
Date*
Date Format: MM slash DD slash YYYY
Initial*
Clearance Warehouse Africa Signature
Date
Date Format: MM slash DD slash YYYY
Initial

Banking Details

BANK:

FIRST NATIONAL BANK

ACCOUNT NO:

62809581665

BRANCH CODE:

250655

PROOF OF PAYMENT:

layby@cwafrica.co.za

072 155 7612

CHEQUE ACCOUNT

VAT NO: 4570281818 | REG NO: 2017/009635/07

SHIPPING & SETUP

RETURNS POLICY

100% SECURE PAYMENT!

Lay-By Form

Lay-Bye Contract

Identity Number (Compulsory)

Payment Schedule Plan

Banking Details