Page 9 - Santa Clara County Superior Court

SECURITY AGREEMENT
BUYER’S NAME
BUYER’S RESIDENCE OR PLACE OF BUSINESS CO-BUYER’S NAME AND ADDRESS
ADDRESS WHERE GOODS PURCHASED WILL BE LOCATED
ZIP CODE
DATE OF CONTRACT AGREEMENT No.
w LINE UP COMPUTER / PRINTER SQUARELY WITH BRACKET BELOW
Bus. Phone
Res. Phone
Salesperson
To be delivered to the following address:
Number of Payments:
One Payment of One Payment of
Payments One Final Payment
Amount of Payments:
When Payments Are Due:
]Semi Mthly. [ ] Mthly. Payments beginning
The foregoing declarations are hereby acknowledged.
DATE
XX
SELLER
BUYER
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
The amount you will have paid after you have made all payments as scheduled.
Total Sale Price
The total cost of your purchase on credit, including your down
payment of $ .
Mos. $ TOTAL INSURANCE PREMIUMS $
(a) 2.
3.
CREDIT INSURANCE AUTHORIZATION AND APPLICATION
You voluntarily request the credit insurance checked below, if any, and understand that 4. such insurance is not required. You acknowledge disclosure of the cost of such insurance
and authorize it to be included in the balance payable under the security agreement. Any
returned or refunded credit insurance premiums shall be applied to sums due under this
contract. Only the persons whose names are signed below are insured.
CREDIT LIFE
JOINT LIFE
CREDIT DISABILITY
Mos. Premium $ Mos. Premium $ Mos. Premium $
5.
TOTAL CREDIT INSURANCE PREMIUMS $ (b) You want Credit Life Insurance You do not want Credit Life Insurance
You want Credit Disability Insurance (Primary Buyer Only) You do not want Credit Disability Insurance
You want Joint Credit Life Insurance
You are applying 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 or certificate for details).
6. AMOUNTFINANCED(4less5) .............................$ (6) *We may retain, or receive, a portion of this amount.
NOTICES: The names and addresses of all persons to whom the notices required or permitted by law to be sent are set forth at the top of this form.
PREPAYMENT REFUND: (Check One Box) Any refund for prepayment will be calculated: According to the Rule of 78. According to the Sum of the Periodic Time Balances.
(If neither box is checked, the method for calculating the prepayment refund will be deemed to be the Sum of the Periodic Time Balances.)
DATE DATE
X
PRIMARY BUYER
X
AGE AGE
ID-1
COMPACNOYMPANY NOT LATER THAN MIDNIGHT OF
Buyer’s Signature X
at
ADDARDEDSRSESS
I hereby cancel this transaction
CO- BUYER
®
1 6 0 1/97
Ptg. 2/08
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.
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
%$$$$ YOUR PAYMENT SCHEDULE WILL BE:
SECURITY: You are giving a security interest in the goods or property being purchased.
LATE CHARGES: ( ) Applies only if checked. If any payment is more than 10 days late you will be charged a delinquency charge of $10.00.
( ) Applies only if checked. If any payment is more than 15 days late you will be charged a delinquency charge of $15.00.
PREPAYMENT: If you pay early, you may be entitled to a refund of part of the finance charge.
See your contract documents for any additional information about nonpayment, default, any required prepayment in full before the scheduled date and prepayment refunds.
STATEMENT OF INSURANCE
NOTICE: No person is required as a condition of financing the purchase of goods or services to purchase, or negotiate, any insurance through a particular
You have requested Seller to include in the balance due under this agreement the following insurance. Insurance is to expire WITH BEFORE AFTER the due date of the 1. final installment. Buyer requests seller to procure insurance upon the described property
against fire, theft, and collision for the term of this agreement. Any insurance will not be in
ITEMIZATION OF AMOUNT FINANCED
A. CashPriceofGoods&Services ........$ (A) B.SalesTax ..........................$ (B) C.Other .............................$ (C)
To whom paid
TOTALCASHPRICE(AtoC)............. ..................$ (1) AMOUNTS PAID TO PUBLIC OFFICIALS
A. RecordingFee ......................$
B. Other(described) ....................$
TOTALOFFICIALFEES(AtoB) ............................$ (2) AMOUNT PAID TO INSURANCE COMPANIES: (TotalpremiumsperStatementofInsurancea+b)* ..............$ (3) TOTAL(1+2+3)......................... ..................$ (4) 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+D+E+F) . . . . . . ..................$ (5)
insurance company, agent or broker.
force until accepted by the insurance carrier.
$ DED., COMP., FIRE & THEFT $ OTHER
Premium Mos. $
BUYER ACKNOWLEDGES THAT PRIOR TO SIGNING THIS CONTRACT HE READ AND RECEIVED A LEGIBLE COMPLETELY FILLED-IN COPY OF THIS CONTRACT MARKED “TRUTH-IN-LENDING COPY.” AND THAT UPON SIGNING, SUCH COPY WAS ALSO SIGNED BY THE PARTIES HERETO, AND HE HAS RECEIVED A COMPLETED DUPLICATE SET OF THE NOTICE OF CANCELLATION AND HAS BEEN ORALLY INFORMED OF THIS RIGHT.
YOU THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT.
Buyer’s Signature X Co-Buyer’s Signature X Seller Address
ByX Title
NOTICE OF CANCELLATION
You may cancel this transaction, without any penalty or obligation, within three business days from the above date. DATE:
If you cancel, any property traded in, any payments made by you under the contract or sale, and any negotiable instrument executed by you will be returned within 10 business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be canceled.
If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this contract or sale, or you may, if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller’s expense and risk.
If you do make the goods available to the seller and the seller does not pick them up within 20 days of the date of your notice of cancellation, you may return or dispose of the goods without any further obligation. If you fail to make the goods available to the seller, or if you agree to return the goods to the seller and fail to do so, then you remain liable for performance of all obligations under the contract.
To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice, or any other written notice, or send a telegram to:
® FORM NO. 160 (REV. 1/97)
© 1996 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.
DADTAETE
DDAATTEE
TRUTH IN LENDING COPY 1. Give to BUYER prior to signing. 2. BUYER and SELLER Sign this copy AFTER contract is signed.
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Not For Reproduction