Finance Application If you are purchasing Bush & Shrub Covers online and would like to use our finance options please fill out this form and then click print so it will print all your information into the form. If you would like to purchase other products displayed on our website and would like to finace or to make a purchase, please contact us via E-mail or by phone. You can either choose from a 4 Month Payment Plan for $9.95, a 5 Month Payment Plan for $14.95, or a 6 Month Payment Plan for $19.95. Please fill out the form below to determine your financing options. We only Accept VISA MASTERCARD & DISCOVER * indicates required fields    *First Name:   *Middle Initial:   *Last Name:   *Stree Address:   *City:   *State:   *Zip Code:   *Phone #:   *Alternate Phone:   *E-Mail:   *Annual Income: Select Your Annual Income $0.00 - $20,000 $20,000 - $40,000 $40,000 - $60,000 $60,000 - $80,000 $80,000 - $100,000 $100,000 +   *What Monthly Plan Would You Like?: Choose Your Monthly Plan 4 Month Plan ($9.95) 5 Month Plan ($14.95) 6 Month Plan ($19.95)   *Method of Payment: Choose Your Payment Method Post-Dated Checks Automatic Debit Payments   *Total Purchase Price:   *Total Finance Fee: Choose your Finance Fee Amount $9.95 (4 Months) $14.95 (5 Months) $19.95 (6 Months)   *Add Total Of Purchase and Finance Fee Together:   *Divide by Your Monthly Payment Plan (4,5, or 6).:   *This is Your Payment, What is Your Payment Method?: Payment Method Post-Date Checks Automatic Debit Payments   AUTOMATIC DEBIT: Type of Card:: What Is Your Card Type? Visa Mastercard Discover   Name On Card:   Card Number:   Expiration Date:   3-Digit Card Verification Code (On Back):   *I Agree To The Terms & Conditions:  Yes  No   *Signature: YOUR FIRST PAYMENT IS DUE AT TIME OF ORDER. (Your 2nd payment will be due on the same day the following month.) (Example: You order on March 10th, your first payment is on March 10th, your 2nd on April 10th and so on.) If you have not already made your purchase you can use our shop online options, or call us at (315) 865-6714 to place your order over the phone. (Note: You will need the Color Name & ID Number for stain finished products, you can get this information from the shop online section of this website, Go to the stain options at the top of the page, click on the view details link below the BEHR Logo on the left side of the website. PLEASE DO NOT SUBMIT THIS FORM. It needs to be printed, Signed and mailed in with your payment information or checks. MAKE ALL PAYMENTS OUT TO: Sure Seal Window Installations PLEASE SEND APPLICATIONS & PAYMENTS TO: Sure Seal Window Installations 7620 Rt. 291 Stittville, NY 13469

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