Apply Now

Please complete the following form to apply or if you prefer to complete the application in writing, you can download it here, and email it to us. Just follow the instructions in the form.

APPLYING IS SIMPLE!

Tell us about the product you want to buy and the store where you would like to get it:

Store Details

Store Name *

Store Phone Number *

Email *

Store Address *

Address Line 1

City

State

Zip Code

Product Details

Product Brand *

Model *

Product Serial Number *

Retail Price *

Color (If relevant)

Customer Information

Layout

First Name *

Social Security Number

Last Name *

Driver's Licence Number

Birthdate *

Customer Phone Number *

Customer Email *

Customer Address *

Address Line 1

City

State

Zip Code

Name of Landlord or Apartment Complex *

Phone Number of Landlord or Apartment Complex *

Montly Payments *

Have you lived at this address for more than 3 months? *

Sources of Income

Current Employer (if none, indicate source of income)

Employer Phone Number *

Job Title/Position

How long at this job? *

Work Hours/Shift *

Employer Address *

Address Line 1

City

State

Zip Code

Name of supervisor *

Supervisor Phone Number

Take Home Pay

Payday Frecuency *

Date of Next Salary Payment

Personal References

Reference #1: Full Name (must be a relative)

Relationship *

Phone *

Address City/State/Zip or Postal Code *

Reference #2: Full Name (must be a relative)

Relationship *

Phone *

Address City/State/Zip or Postal Code *

Reference #3: Full Name

Relationship *

Phone *

Address City/State/Zip or Postal Code *

Reference #4: Full Name

Relationship *

Phone *

Address City/State/Zip or Postal Code *

Drivers License

Click or drag a file to this area to upload.

Upload drivers license

Paystub

Click or drag a file to this area to upload.

Upload paystub

I am at least 18 years old
I have read and accepted the terms of use
LowWeeklyPayments will process all applications within 24 hours. Upon review, we may request additional documents to verify details in your application. You can see the full list of documents we may request here

Please read our Terms of use and conditions page

Check if you agree *

I agree