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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 purchases through our “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. 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:_______________________________