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<br />RETAIL INSTALLMENT CONTRACT
<br />HOME SOLICITATION SALE
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<br />WHITE - ORIGINAL
<br />BWE - BUYER
<br />BWE - BUYER
<br />GREEN - DEALER
<br />CANARY - TIL
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<br />Co-Buyer
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<br />Buyer (Print ~r Ty ;tJI ~ E ~'~' '-
<br />Name . V - / 11/ f /
<br />I ' '_'-.If
<br />Stre~Addres;..., 'J J J \1 /( I ~ ~ < /:J J
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<br />City & State , /) A ~
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<br />Seller (Creditorl ___
<br />Name & Addre~s4 a 5T?f It:..
<br />Salesman's Name & Address
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<br />Street Address
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<br />City & State
<br />
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<br />_.- I~.~. "',IV 7
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<br />I /Ii'? fie /I L1 License Number
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<br />License Number
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<br />Te.lePhone Number,,/ Ico~act Date ,I
<br />/0$1 -;(O7~ c,... ;ZO- t;~
<br />Telephone Number
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<br />Serial No Description (Goods/Services)
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<br />/~Wt:.~,fe .II, ~1C)V 5;{:.kd:/':':-'
<br />_,_ J C:-7: I C- U ~ . . r:::.
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<br />~ -l-iER r/.i.J~
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<br />AMOUNT
<br />$ 4~ /Xi, (.1,~
<br />$
<br />$
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<br />List security retained from previous Contract:
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<br />The Buyer agrees to purchase the above described goods and services, hereafter called "property"
<br />for the Total Sale Price. '
<br />Buyer promises to pay Seller the total of payments in consecutive monthly payments according
<br />to the payment schedule shown opposite. Interest after maturity shall accrue at the highest lawful
<br />contract rate. .
<br />A security interest in the property shall remain in the Seller or his assignee under the Uniform
<br />Commercial Code until this Security Agreement is fully performed. Buyer hereby acknowledges delivery
<br />and possession of the property. The property shall remain personal property and shall not become
<br />real property no matter how affixed thereto.
<br />Buyer also promises to pay to the Seller or other holder of this Security Agreement a late charge
<br />on each payment of this Security Agreement in default more than 10 days in an amount equal to
<br />5% of each such payment.
<br />If the indebtedness is accelerated or prepaid in full, the Buyer will be allowed a rebate of the
<br />unearned portion of the finance charge, after first deducting an acquisition charge of $15.00 for
<br />the months prepaid computed by the "Rule of 78's", provided, however, if this contract is dated
<br />on or after October 1, 1993, and has an original term of more than 61 months, the rebate will be
<br />computed according to the actuarial method, after first deducting an acquisition charge of $15.00.
<br />The following minimum charge may be retained by the Seller; $12.000, if the amount is $50.00
<br />or more, $7.50, if the amount financed is greater than $25.00 but less than $50.00; or $5.00 if the
<br />amount financed is $25.00 or less. No refund of less than $1.00 will be made.
<br />Seller may, at its option, add subsequent purchases of goods and/or services made by Buyer
<br />to this agreement, in which event all terms and conditions hereof shall apply equally thereto, and
<br />the total price of such additional goods and/or services, the finance charge and installment pay-
<br />ments may be increased. Goods purchased under previous contracts shall be security for the goods
<br />purchased under subsequent contracts until such time as the deferred payment price under the
<br />previous contract is fully paid.
<br />Each payment on this agreement shall be allocated to the purchases made on this agreement
<br />and to all previous installment purchases not paid for in full as of this date on the basis that the
<br />items first purChased shall be deemed first paid for, and, in the case of items purchased on the
<br />same date, the lowest priced item shall be deemed first paid for. The Seller's security interest in
<br />the goods shall cease as each item is paid in full.
<br />The Buyer and Seller agree to the "Statement of Additional Covenants" set forth on the reverse
<br />side hereof, which the undersigned each agree shall constitute a part of this Security Agreement.
<br />
<br />Same as Cash Option
<br />
<br />o If checked and signed or initialed below by the Seller and Buyer, this contract contains a "Same
<br />as Cash" Option. If you pay the entire Unpaid Balance of Cash Price (Line C) and the Net Un-
<br />paid Balance on Prior Contract (if anYI (Line D) within of the date of this
<br />contract, no Finance Charge will be assessed, and all other charges (if anYI will be rebated.
<br />The "Same as Cash" option is void unless you pay each regular monthly payment when due
<br />during the "Same as Cash',' period,
<br />
<br />If the Contract is not prepaid as described above during the "Same as Cash" period, the "Same
<br />as Cash" period is not interest-free.
<br />
<br />Seller: Buyer:
<br />
<br />Credit Insurance is not required to obtain credit. I understand I may elect to purchase credit insur-
<br />ance from the Seller or I may assign a policy I already have or I may buy a policy from anyone
<br />I choose to cover this transaction. The only insurance we provide is through an affiliated company
<br />of the assignee of this Security Agreement and that company expects to profit from the insurance.
<br />Credit Life Insurance I want Credit Life Insurance.
<br />'\.
<br />X r.
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<br />I want Credit Accident and Health Insurance.
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<br />Premium $
<br />Credit Accident and
<br />Health Insurance
<br />Premium $
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<br />X
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<br />ITEMIZATION OF AMOUNT FINANCED
<br />CASH PRICE ........... .. .. .. .. .. .. . .. $'1-& In), d '~A
<br />CASH DOWN PAYMENT ..... $ ~-.:; t>t>,. "-0
<br />TRADE-IN ................ $ {ff
<br />. , ,
<br />
<br />(Describe)
<br />lUTAL DOWN PAYMENT ..................... $
<br />UNPAID BALANCE OF CASH PRICE (A MINUS BI $
<br />NET UNPAID BALANCE ON PRIOR CONTRACT ... $
<br />OTHER CHARGES:
<br />TO INSURANCE COMPANIES:
<br />CREDIT LIFE INSURANCE $
<br />ACCIDENT & HEALTH
<br />INSURANCE .......... $
<br />PROPERTY INSURANCE $
<br />NON-FILING INSURANCE $ ;:! 5',. . p(j
<br />TO PUBLIC OFFICIAlS...' $ I ~',3.? ,0 1'~ 3-5'
<br />lUTAL OTHER CHARGES ... '." '... . . .. ... $ '- ~, . E
<br />AMOUNT FINANCED (C+D~EI..:...".. .'.', ,. .$"" /39, 3 '5 F
<br />
<br />::)/)1), /'J..tl B
<br />?'t / ()-() , vCl C
<br />I!f D
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<br />DISCLOSURE STATEMENT
<br />AMOUNT FIN.ANCED (The amount, of c,r,e dit , , AI., / ,~ ~' 3 ~
<br />proVided to you or on your behalf) $ 'ZZ...lL _' oJ
<br />FINANCE CHARGE (The dollar amount. the !' '. GlI rj, .P I 0
<br />credit will cost youl ' " ' $ . ,
<br />lUTAL OF PAYMENTS (The amount you will,":'" ,
<br />have paid after you, have fj'lade all. / ~~L'" "'ZI'
<br />payments as scheduledl", ,'" :~'. ~$ f#? i/V J I ...xp F+G
<br />lUTAL SALE PRICE > (The total cost of your..'. .
<br />purChase on credit,'incl~i~lI wu~ /- ~ ('5':
<br />downpaymentof$ ~OV, ".).:.$lp V ,
<br />ANNUAL PERCENTAGE RAT, E ,.,.,(The ~t.o, ~.~ . .
<br />your credit as a yearly ratel J JJ. 71.. "0/0
<br />
<br />
<br />Your payment schedule will be: ., "
<br />
<br />Number of Amount of When Payments Are Due
<br />Payments Payments
<br />
<br />'PO
<br />
<br />$/0''''', A onthIY,/'O'" ""0 C
<br />J v Starting - tX. - I
<br />
<br />$
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<br />Security: You are giving a security interest in the goods or property being
<br />purchased. Property sectiring'anotlier'conti\ct\Withus 'may also
<br />secure this contract. . ,
<br />late Charge: If a payment is more than'10 days late, you will be charged
<br />5% of the payment.
<br />Prepayment: If you pay off early, you wiD be entitled to a refund 01 part of the
<br />finance charge.
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