Customer Layaway Payment Form

	- REQUEST YOUR APPOINTMENT - The Wedding Super Store
Louisville Ky - Nashville Tn - Evansville In - Elizabethtown Ky
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Layaway Payment Processing

Thank you for choosing Bridal Warehouse's online Layaway Payment Option.
It is easy and quick. To help ensure your payment is applied correctly make sure you select the correct store and enter the Customer Name as it appears on your layaway contract.

YOUR LAYAWAY CONTRACT INFORMATION: *Indicates required items

Select Bridal Warehouse Layaway Location *:
Customer Name on Layaway Contract *

Wedding Party Name (Bride first & last name) Event Date* mm/dd/yyyy

Please process my credit card for the following payment amount. * Enter amount including cents (ex. $120.99)

PAYMENT INFORMATION
Please enter your credit card information.

Name as it appears on Credit Card *

Credit Card Billing Address
Address * City * State * Zip *
Phone # * (Please enter as follows : 111-222-3333)

Type of Credit Card
Enter type of card or select please call for Card Number.

Credit Card Number* Credit Card CVV Code * Card Expiration MM-YY *

The purchaser understands all sales are final. Deposits on merchandise are non-refundable. All merchandise is sold as is. Layaway deposits cannot be refunded or transferred to another department or customer for any reason. It is the total responsibility of the purchaser to make payments on time. Bridal Warehouse will not notify purchaser of payments past due. A Layaway with a payment ten (10) days past due will be considered abandoned by the purchaser, all monies will be forfeited and all merchandise will be disposed. Bridal Warehouse reserves the right to correct all clerical and/or calculation errors.

Thank You for choosing Bridal Warehouse.