Sample Layaway Receipt from FTC

Your Store

Customer Name _________________ Date _________
Address ________________________ Layaway No. ____
Telephone ______________
Description of Layaway Merchandise ___________________

We will remove this merchandise from the sales floor.
[Or: We will not remove this merchandise from the sales floor,
but we will mark it “sold”.]
[Or: The merchandise must be ordered. We will order your layaway item
when you have paid half of the purchase price.]

Payment Terms
Your payments of at least $ _____ are due on the _______ day of each month, for ___ months, beginning ______. Final payment is due by _____.
Sales Price ______
Sales Tax ______
Layaway Charge ______
Other Charges ______ (specify)
Total Price ______
Less Deposit ______
Balance Due ______

[Note: a free printable layaway plan record for retailers can be found at]

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