LaYourPanacheAway II

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HerPanache.com is pleased to offer a layaway incentive to you, our valued customers, in effort to accommodate your Custom Panache and qualified shoe purchases (items that are $150 and up) through our exclusive “LaYourPanacheAway Program�. For your ordering convenience, we have a 30-day layaway program which requires a deposit of 50% down and the remaining balance to be paid within 30 days that can either be paid weekly or bi-weekly. Due to the nature of the business, your Custom Panache layaway deposit and payments are NON-REFUNDABLE. All other items are subject to a 30% RE-STOCKING FEE. For this, we encourage you to only use our LaYourPanacheAway Program if you are absolutely certain that you want the item(s) that you order. Payments must be made regularly, as scheduled, and must be received by us, on or before the day they are due, unless you opt to make the remaining payments in full on or before one of the scheduled payment dates. You can make payments by calling us at 773-234-3159, e-mailing us at the e-mail address provided below or using the PayPal payment link that you will be assigned to. Once payment has been made in full, your item(s) will be processed for shipping within two business days (with tracking and insurance). The layaway period starts from the date that we receive this signed form AND your 50% deposit. Please fill out this form and e-mail it to sales@herpanache.com to begin the layaway process. Upon receipt of your completed LaYourPanacheAway Agreement, we will send a money request or payment link for the 50% deposit where you will be able to either log into your PayPal account or pay securely via debit/credit.

PLEASE COMPLETE THE PAYMENT SCHEDULE BELOW WITH THE APPROPRIATE SCHEDULE, AMOUNTS AND PAYMENT DATES!!

Preferred Payment Schedule (Initial One): 30-day (weekly)________________________ 30-day (bi-weekly)______________________

30-day (weekly amounts and dates): Deposit___________________________ Payment #2 _______________________ Payment #3_______________________ Payment #4 ______________________ Final Payment_____________________

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30-day (bi-weekly amounts & dates): Deposit __________________________ Payment #2 ______________________ Final Payment ____________________

Item SKU Number(s): _________________________________________________________________________ Purchase Amount: _________________________ Shipping/Handling: ________________________ Tax (7% - If shipped within IL): _______________ Total Amount Due: ________________________

By signing this form below, you acknowledge that you are 18 years or older and are entering a legal, binding agreement according to our LaYourPanacheAway Agreement terms as listed above. Customer Name: ______________________________________________________________________________ E-mail: ______________________________________________________________________________________ Address: _____________________________________________________________________________________ City: ________________________________ State: __________________ Zip: ____________________________ Day Phone: _____________________________________ Cell Phone: ____________________________________ Customer Signature: ______________________________________ Date:_______________________________

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