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Credit Insurance Election:  CREDIT LIFE INSURANCE AND CREDIT DISABILITY INSURANCE are not required to obtain this loan, and will not be provided unless you sign below and agree to pay the additional cost for this insurance.  THIS INSURANCE IS NOT IN EFFECT UNTIL YOU APPLY FOR IT, THE INITIAL PREMIUM IS PAID, AND THE INSURANCE COMPANY ISSUES THE POLICY.

Type

Premium

Signature

CreditLife

$

I want credit life insurance:

Signature

Credit Disability

$

I want credit disability insurance:

Signature

Credit Life & Disability

$

I want credit life and disability insurance:

Signature

I do not want any such insurance or information on it.

$

 

Signature


Security:     You are giving a security interest in:

                        the goods or property being purchased.


(brief description of other property)

 

Late Charge:  If a payment is late, you will be charged $                    /                    %

 

Prepayment:  If you pay off early, you        may,     will not have to pay a penalty:

                                    may,     will not be entitled to a refund of part of the finance charge.

Assumption:  Someone buying your house may,     may not subject to conditions, be allowed to assume the remainder of the mortgage on the original terms.

See your contract documents for any additional information about nonpayment, default, any required payment in full before the scheduled date, and prepayment refunds and penalties.

Please acknowledge receipt of the above information by signing below:  

I ACKNOWLEDGE RECEIPT OF A COPY OF THE FOREGOING DISCLOSURE STATEMENT WITH ALL BLANKS APPROPRIATELY 

FILLED ON THE  nbsp;                              DAY OF                                                                    

                                                                                                                                               

BORROWER

                                                                                                                                               

CO-BORROWER OR AGENT

If mailed, mailed by                                                                    Date



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