We offer 12 months No Interest. Please fill out this form to apply. By submitting this form you are authorizing ParkHill Jewelry to check your credit and see if you qualify for the 12 months no interest program. After you are approved, you will receive an application to sign and return before your account is activated.

Applicants Name:
Co-Applicants Name:
Street:
City:
State:	Zip Code:
Phone:
Fax:
Email:
Applicants SS#:
Co-Applicants SS#:
Applicants Date of Birth:
Co-Applicants Date of Birth:
Number of years at address:

Applicants Employment Information
Applicants Employer:
Position:
Employers Phone #:
Length of Employment:
Monthly Income:

Co-Applicants Employment Information
Co-Applicants Employer:
Position:
Employers Phone #:
Length of Employment:
Monthly Income:

Housing Information
Own Your Home	Rent Your Home	Buying Your Home

Mortgage Company/Landlord:
Monthly Payment/Rent

Comments or Questions

228 North Prince Street, Lancaster, PA 17603 - (717) 394-4444

5 West Main Street, Ephrata, PA 17522 - (717) 733-8800

sales@parkhilljewelry.com