10-1-689. Example of form.

The following form is an example of the form which may be used to satisfy the disclosure requirements of subsection (b) of Code Section 10-1-682, requiring that the disclosures described in paragraphs (1), (2), (3), (4), (9), (12), and (13) of subsection (a) of Code Section 10-1-682 be made clearly, conspicuously, prominently, and together in sequence: LEASE-PURCHASE DISCLOSURES

1. Description of leased property:

Item Quantity Serial # Mfg. Model Condition

2. Total payment due at beginning of contract:

Lease payment:

Delivery charge:

Sales tax:

Other:

Total:

3. Lease payments:

1. You may renew the lease weekly or monthly as you choose.

2. The weekly rental is $ .

3. The monthly rental is $ .

4. Other charges:

1. Reinstatement fee $

2. (Specify all others)

5. Cost of lease:

If you renew this lease each week/month for weeks/ months,

you will pay a total of $ to own this property. This total in-

cludes all costs included in the first lease payment.

6. Estimated fair market value of the leased property:

The estimated fair market value of the property you are leasing

is $ .

7. Cost of lease services:

The difference between the amount in item 5 and item 6 above is

$ . This is the cost of services to you under this lease if

you elect to renew this lease for the number of terms necessary

to acquire ownership of the leased property.

I have read the above statement before signing this agreement.

Date: Lessee:

Date: Lessee: