subject_line
Make your Layaway Payment
Account First Name
*
Last Name
*
Ticket#
*
At which location was your purchase made?
*
Ceredo, WV
The Huntington Mall
(For Verification Purposes Only) Street Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Phone Number
*
Email Address
*
Payment Amount:
*
Payment Type
*
One Time Payment
Auto Monthly Withdraw (Next payment would be drafted 30 days from TODAY)
Would you like to have your items shipped to your home for an additional $15 when layaway is paid in full? Choose one.
*
$15 Shipping to home
FREE In-store Pick-up
Name on Card
*
Credit Card Type
*
Visa
MasterCard
American Express
Discover
RoseTree Charge
Credit Card Number
*
Expiration Date (mm/yy)
*
3 or 4 digit code
*
Please Check This Box to agree to the in store layaway and special order contract and policy with this payment.
The contract can be read at the link below
*
🛈
----By checking this box, I hereby agree to all terms and conditions as stated in the RoseTree Boutique Contract and am providing my electronic signature to authorize the RoseTree Boutique to draft the above payment.-----
RoseTree Sales Policy and Contract
Please sign here that you agree to all policies & contracts. Special Orders & Layaways are a final sale.
*
clear
Additional Comments: