Fill and Sign the Agreement Credit Form

Agreement to Repay Cash Advance on Credit Card Agreement made on the ___ day of __________, 20___, between __________________ of ____________________________________ (street address, city, county, state, zip code) , referred to herein as Lendor , and __________________ of ____________________________________ (street address, city, county, state, zip code) , referred to herein as Borrower. Whereas, Lendor advanced Borrower the sum of $_______________ on the ____ day of ______________, 20___ by obtaining a cash advance on ______________________________ (Name of Credit Card Company) Account Number _________________, hereafter called Credit Card; Whereas, the unpaid balance of said cash advance is $__________________, and is hereafter referred to as Debt; Whereas, Borrower has agreed to repay said Debt pursuant to the terms of this Agreement; Now, therefore, for and in consideration of the mutual covenants contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: I. Borrower shall repay Debt by paying Lendor, on or before the _____day of each month, a sum equal to at least the minimum amount due on the said Credit Card . II. Borrower shall completely payoff said Credit Card Debt, including any interest charged by ____________________________________ (Name of Credit Card Company), on or before the _____ day of __________, 20____; III. With Lendor’s written consent, Borrower may extend this Agreement for one year; IV. Payments to Lendor shall be made at the address set forth above, or to such other place as Lendor shall indicate in writing to Borrower. V. If Borrower shall default in any of the payments specified herein, then Lendor may, at his option, declare the whole sum then remaining unpaid immediately due and payable. VI. Upon any such default, Borrower shall pay Lendor all costs of collection, including reasonable attorneys’ fees. WITNESS our signatures as of the day and date first above stated. ________________________ ________________________ - 1 - LENDOR BORROWER - 2 -