Joyeria Daisy

START

First name *

Last Name *

SSN/ITIN *

Confirm SSN/ITIN *

Mobile phone *

(Optional) Yes! I would like to receive marketing communications at the number provided above from or on behalf of Progressive Leasing. These communications may be delivered using an autodialer or a prerecorded message. Consent is not a condition of application, lease, or purchase. For text messages, message and data rates may apply. Text STOP to cancel future marketing messages. Text HELP for help. Message frequency is recurring.

APPLICANT INFORMATION

Street Address *

Apt#

City *

State *

Zip Code *

Email *

APPLICANT IDENTITY VERIFICATION

Date of Birth *

ID Type *

State *

ID Expire Date *

ID Number *

Secondary ID Type

Issuer

Expiry Date

APPLICANT PRIMARY INCOME

Income Source *

How are you paid? *

Monthly Gross Income *

Payment Frequency *

PAYMENT INFORMATION

Bank Routing Number *

Bank Account Number *

Credit Card Number *

Expire Month *

Expire Year *

Credit Card CVV *

First Name *

Last Name *

Credit Card Billing Address

Same as Home Address

Street Address *

Apt#

City *

State *

Zip Code *

Terms & Condition

I certify that I provided complete and accurate information on my application.

I authorize Prog Leasing, LLC and/or affiliates (“Progressive”) to obtain reports from consumer reporting agencies and verify information provided. I agree that Progressive may use my consumer reports to any lawful purpose, such as: (1) authenticating my identity; (2) making lease-to-own eligibility decisions; (3) assisting with internal modeling and analysis; (4) serving my account through the life of my lease and (5) verifying information in my application.

I authorize Progressive to share information regarding my application, including the decision, with the Retailer.

I have read, and I agree to all of the above statements. I further agree to Terms of Use, Privacy Policy, Arbitration Provision, Application Disclosure, E-Sign Disclosure.

I understand that by clicking on the SUBMIT button immediately following this notice, I am providing 'written instructions' to Acima Digital, LLC under the Fair Credit Reporting Act Authorizing Acima Digital, LLC to obtain information from my personal credit profile or other information from Experian/Clarity and other agencies. I authorize Acima Digital, LLC to obtain such information to evaluate the terms of any merchandise lease offer, to confirm my identity, and to avoid fraudulent transactions in my name. I also understand that by clicking "submit" I am agreeing to the Application Terms, Privacy Policy, Terms of Service, and ESIGN disclosure. Additionally, by checking this box I agree to allow Acima Digital, LLC to share my application data with Joyeria Daisy LLC.

I Consent: By checking this box, you agree Acima Digital, LLC ("Acima") and its agents may deliver telemarketing calls and text messages regarding Acima goods, services or offers to you at the telephone number provided on this application using an automated system for the selection or dialing of telephone numbers. You understand that you are not required to consent to marketing calls and text messages in order to obtain goods or services from Acima or open an Acima account. If you do not consent, Acima may still send you text messages regarding important account information, such as transaction details or servicing information. By checking this box you certify that you are authorized to provide this consent.