Legal Credit Disclosure Form

LEGAL CREDIT DISCLOSURE FORM

This Legal Credit Disclosure Form is entered into on this Effective Date: by and between Creditor Name: (Creditor), and Debtor Name: (Debtor).

Individual    Corporation    Limited Liability Company    Other

Individual    Corporation    Limited Liability Company    Other

RECITALS

WHEREAS, Creditor is willing to extend credit to Debtor on the terms and conditions set forth in this Legal Credit Disclosure Form; and

WHEREAS, Debtor desires to borrow or otherwise obtain credit from Creditor and acknowledges receipt of the specific credit terms disclosed below; and

WHEREAS, the parties intend that this document constitute the binding written disclosure of credit terms governing the transaction described herein.

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows:

1. DEFINITIONS

For purposes of this Form: "Annual Percentage Rate" or "APR" means the cost of credit as an annual rate; "Finance Charge" means the dollar amount the credit will cost; "Amount Financed" means the principal amount of credit provided to the Debtor; "Total of Payments" means the sum of all scheduled payments payable by Debtor. Capitalized terms used but not defined shall have their ordinary commercial meaning.

2. DISCLOSED CREDIT TERMS

(a) Principal or Amount Financed: $

(b) Finance Charge (estimated): $    (c) Annual Percentage Rate (APR):

(d) Total of Payments: $    (e) Number of Scheduled Payments:

(f) Regular Payment Amount: $    (g) Payment Frequency:    (h) First Payment Due Date:

(i) Late Payment Charge: (applies if payment is not received within days of due date).

(j) Prepayment: Debtor may prepay all or part of the principal at any time without penalty: Prepayment Allowed    Prepayment Penalty Applies

3. SECURITY AND COLLATERAL

This obligation is: Secured    Unsecured. If secured, security interest description and collateral are as follows:

Creditor will retain a security interest in the collateral described above and may file financing statements or similar instruments to perfect and protect Creditor's interest.

4. DEFAULT AND REMEDIES

Events of Default include failure to make any payment when due, insolvency of Debtor, false representation, or breach of any material covenant. Upon Event of Default, Creditor may declare all amounts due and payable, accelerate the debt, exercise rights against collateral, collect costs of collection, and pursue all remedies available at law or in equity without prior notice except as required by applicable law.

Creditor's exercise of one remedy is not a waiver of other remedies. Creditor shall take commercially reasonable steps to mitigate damages following default where mitigation is required by applicable law.

5. NOTICE AND CURE

Prior to acceleration or enforcement actions, Creditor will provide written notice to the address for notices set forth below and afford Debtor any cure period required by applicable law. Notices shall be sent to the contact information designated in Section 6.

6. NOTICES

Notices are effective upon receipt or upon refusal of delivery at the designated address. Each party must promptly notify the other in writing of any change to the notice address.

7. TAXES, FEES, AND COSTS

Debtor is responsible for all taxes, filing fees, recording fees, and reasonable costs of perfecting and maintaining Creditor's security interest, except to the extent prohibited by applicable law. Collection costs, court costs, and attorneys' fees incurred to enforce this Agreement are payable by the defaulting party where permitted by law.

8. REPRESENTATIONS, WARRANTIES AND ACKNOWLEDGMENTS

Debtor represents and warrants that the information provided to Creditor is true, complete and accurate, and that Debtor has the authority to enter this Agreement. Debtor acknowledges receipt of a completed copy of this disclosure at or before execution.

Debtor Initials:     Creditor Initials:

9. MISCELLANEOUS

Governing Law: This Agreement shall be governed by and construed in accordance with the substantive laws of the jurisdiction chosen by the parties below without regard to conflicts of laws principles.

Entire Agreement: This document constitutes the entire agreement and disclosure of credit terms between the parties with respect to the subject matter and supersedes all prior negotiations, proposals, and agreements, whether written or oral.

Severability: If any provision of this Agreement is held invalid or unenforceable, the remainder of the Agreement will remain in full force and effect.

Amendments; Waiver: No amendment, modification or waiver of any provision of this Agreement will be effective unless in writing and signed by both parties. No waiver of any breach will be deemed a waiver of any subsequent breach.

Counterparts: This Agreement may be executed in counterparts, each of which is an original and all of which together constitute one instrument. Facsimile or electronic signatures will be treated as originals for all purposes to the extent permitted by law.

10. GOVERNING JURISDICTION

The parties select the following governing jurisdiction for interpretation and enforcement of this Agreement: .

CERTIFICATION

By signing below, each signatory certifies under penalty of perjury that the information contained in this Legal Credit Disclosure Form is true and correct to the best of their knowledge, that they are authorized to enter into this Agreement, and that they have received a copy of this disclosure.

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