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APPLICATION FORM
please fill out all blank fields properly and use the print button on your browser to print this application form

First Name MI Last Name Suffix

Street Address
City State ZIP Code

Home Phone Number
First Name on Phone Bill Last Name on Phone Bill

Date of Birth (MM-DD-YYYY)
(You must be eighteen years or older to apply)
Social Security Number

Mother's Maiden Name/ Security Password
This name/password will be used to verify your identity when you call.
Years at
residence
Residential Status
Rent Own Other

Occupation
Annual Income Other Annual Household Iincome

Company Name
Time at Company Business Phone Number

Driver's License or State ID
Primary Vehicle Owned or Leased in Household
Number or State Make and Year (YYYY)

Savings Account
Checking Account Investment Money Market Account
Yes No Yes No Yes No


Signature: . . . . . . . . . . . . . . . . . . .

Date: . . . . . . . . . . . . . . . . . . . . . .


TERMS AND CONDITIONS

  • You will receive monthly statements unless your account balance is $0.00.
  • You pay no interest for 30 days from the order placement date. You must pay off the balance on your account within those 30 days to avoid any interest payments on your purchases.
  • Grace Period: 30 days.
  • Annual Percentage Rate (APR): 17.95% annual percentage rate (APR) thereafter.
  • Variable Rate information: Your APR may vary from month to month. It is calculated by adding 13.25% to the Prime Rate.
  • Default Rate: When you fail to make your minimum monthly payment on time, your account will be in default. The default rate is calculated by adding 22.00% to the Prime Rate, which is 26.75% APR as of September 2002.
  • Late fee: $9.99.
  • Over-limit Fee: $0.00.
  • Statement Fee: $0.00.
Note: Those terms and conditions may be revised periodically. You will receive a 60-day advance notice of changes.

Please, mail your application form
to our mailing address:

Liturgix.com
P. O. Box #181862
Coronado, CA 92178
USA

You are welcome to contact us with additional questions, or should you have difficulties completing your order
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