Page 11 - Santa Clara County Superior Court

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FORM NO. 164S (11/00) CALL 1-800-344-0996 ©2000 THE REYNOLDS AND REYNOLDS COMPANY Ptg. 1/07
SECURITY AGREEMENT
Buyer (and Co-Buyer) Name and Address (including County and Zip Code) Creditor - Seller (Name and Address)
In this contract the words “we”, “us” and “our” refer to the creditor (seller) named below or, upon any assignment, its assignee. The words “you” and “your” refer to the buyer and co-buyer if any named herein.
We sell you the goods and services described below on credit. The credit price is shown below as the “Total Sale Price.” The “Cash Price” is also shown below. By signing this contract you choose to buy goods and services on credit and agree to pay the Total Sale Price, according to the schedules, terms and agreements shown on the front and back of this contract. If this contract is signed by a buyer and co-buyer, each is individually and together responsible for all agreements in the contract.
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SEE OTHER SIDE FOR ADDITIONAL TERMS AND AGREEMENTS:
NEW/ USED MODEL
ANNUAL PERCENTAGE RATE
The cost of your credit as a yearly rate.
SERIAL NO. DESCRIPTION OF GOODS & SERVICES
DISCLOSURES PURSUANT TO THE TRUTH-IN-LENDING ACT
FINANCE CHARGE
The dollar amount the credit will cost you.
Amount Financed
The amount of credit provided to you or on your behalf.
Total of Payments
Total Sale Price
%$$$$ YOUR PAYMENT SCHEDULE WILL BE:
One Payment of One Payment of
Payments One Final Payment of
[
] Wkly. [
] Semi Mthly. [
] Mthly. Payments beginning
Number of Payments:
Amount of Payments:
When Payments Are Due:
SECURITY: You are giving a security interest in the goods or property being purchased.
LATE CHARGES: If payment is not received in full within 10 days after it is due, you will pay a late charge of $10.
PREPAYMENT: If you pay early, you may be entitled to a refund of part of the finance charge.
See your contract documents for any additional information about nonpayment, default, any required prepayment in full before the scheduled date, prepayment refunds and security interest.
STATEMENT OF INSURANCE
NOTICE: No person is required as a condition of financing the purchase of goods or services to purchase, or negotiate, any insurance through a particular insurance company, 1. agent or broker.
You have requested Seller to include in the balance due under this agreement the following insurance. Insurance is to expire WITH 􏰀 BEFORE 􏰀 AFTER 􏰀 the due date of the
final installment. Buyer requests seller to procure insurance upon the described property
against fire, theft, and collision for the term of this agreement. Any insurance will not be in
force until accepted by the insurance carrier. Premium
$ DED., COMP., FIRE & THEFT Mos. $
$ OTHER Mos.$ 2.
ITEMIZATION OF THE AMOUNT FINANCED
Total Cash Price
A.CashPriceofGoods&Services ......$ (A) B.SalesTax ........................$ (B) C. Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ (C)
To whom paid
TotalCashPrice(AthroughC) ...........................$ (1) Amounts Paid To Public Officials
A.RecordingFee ....................$
B. Other (describe) $
TotalOfficialFees .....................................$ (2) Amount Paid To Insurance Companies:
(Total premiums per Statement of Insurance a + b)* . . . . . . . . . . . . $ (3) Total(1+2+3) ..........................................$ (4) TotalDownpayment ....................................$ (5) A. Agreed value of
PropertyTradedin .................$ Describe
B.LessPayOff ......................$ C.Trade-In (AlessB).................$ D. Deferred downpayment due before
secondinstallmentpayment ..........$
E.MFR’SRebate.....................$
F.Remainingcashdownpayment ........$
Total Downpayment (5C through 5F) . . . . . . .................$ (5) AmountFinanced(4less5)............. .................$ (6) * We may retain, or receive, a portion of this amount.
BUYER X CO-BUYER X SELLER X
3.
4.
5.
6.
􏰀 Credit Life:
􏰀 Credit Disability
􏰀 Buyer Term
􏰀 Co-Buyer Exp.
$ $ $
􏰀 Both Premium
Credit Life
Credit Disability
Total Credit Insurance Premiums Insurance Company Name
Home Office Address
Mos. Mos.
(b)
Total Insurance Premiums $ (a)
Application for Optional Credit Insurance
Credit life insurance and credit disability insurance are not required to obtain credit. They will not be provided unless you sign and agree to pay the extra cost.
You are appliying for the credit insurance marked above. Your signature below means that you agree that: (1) You are not eligible for insurance if you have reached your 65th birthday. (2) You are eligible for disability insurance only if you are working for wages or profit 30 hours a week or more on the Effective Date. (3) Only the Primary Buyer is eligible for disability insurance. DISABILITY INSURANCE MAY NOT COVER CONDITIONS FOR WHICH YOU HAVE SEEN A DOCTOR OR CHIROPRACTOR IN THE LAST 6 MONTHS (Refer to “Total Disabilities Not Covered” in your policy for details).
X
X
PREPAYMENT REFUND: (Check One Box) Any refund for prepayment will be calculated:
􏰀 According to the Rule of 78s. 􏰀 According to the Sum of the Periodic Monthly Time Balances.
(If neither box is checked, the method for calculating the prepayment refund will be deemed to be the Sum of the Periodic Monthly Time Balances.)
DATE DATE
BUYER SIGNATURE AGE CO-BUYER SIGNATURE AGE
Notice To Buyer: (1) Do not sign this agreement before you read it or if it contains any blank spaces to be filled in. (2) You are entitled to a completely filled-in copy of this agreement. (3) You can prepay the full amount due under this agreement at any time and obtain a partial refund of the finance charge if it is $1 or more. Because of the way the amount of this refund will be figured, the time when you prepay could increase the ulitmate cost of credit under this agreement. (4) If you desire to pay off in advance the full amount due, the amount of the refund you are entitled to, if any, will be furnished upon request.
Buyer acknowledges that: (1) before signing this agreement Buyer read both sides of this agreement and received a legible, completely filled-in copy of this agreement; and (2) Buyer has received a copy of every other document that Buyer has signed during the contract negotiation.
Buyer Signature X Seller
FORM NO. 164S (REV. 11/00)
©2000 Reynolds and Reynolds ORDER TOLL FREE 1-800-344-0996 THE PRINTER MAKES NO WARRANTY, EXPRESS OR IMPLIED, AS TO CONTENT OR FITNESS FOR PURPOSE OF THIS FORM. CONSULT YOUR OWN LEGAL COUNSEL.
Date
Co-Buyer Signature X Address
By X
Date
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Title
TRUTH IN LENDING COPY 1. Give to BUYER prior to signing. 2. BUYER and SELLER Sign this copy AFTER contract is signed.
The total cost of your purchase on you have made all payments as credit, including your down
The amount you will have paid after
scheduled.
payment of $ .
Not For Reproduction