Consumer Payment Agreement

CONSUMER PAYMENT AGREEMENT

1. DESCRIPTION OF ACCOUNT. The Creditor designated below ("we", "us", "our") agrees to provide Consumer ("you", "your") with a credit account which allows for flexible repayment of your account charges under the terms and conditions stated below. You agree to pay for all Purchases, Services, Goods, Finance Charges and Other Fees and/or Charges made and/or incurred on your Credit Account as outlined below.

2. PAYMENTS. No offer shall be binding unless accepted and confirmed in writing by the Creditor. Acceptance of partial payments by the Creditor will not constitute an agreement or payment arrangement unless otherwise agreed to and confirmed in writing by the Creditor.

SIGNEE AGREES TO PAY THE CREDITOR THE FOLLOWING AMOUNT AS OUTLINE IN THE TERMS AND CONDITION OF THIS CONTRACT:

BALANCE: $ __________  AND AGREES TO MINIMUM WEEKLY PAYMENTS OF $___________, WHICH SHALL COMMENCE ON THIS DATE: ____________, UNTIL PAID IN FULL.

MINIMUM BI-MONTHLY PAYMENTS OF $_______, TO COMMENCE ON THIS DATE: ____________, UNTIL PAID IN FULL.

MINIMUM MONTHLY PAYMENTS OF $__________, TO COMMENCE ON THIS DATE: ____________, UNTIL PAID IN FULL.

3. FINANCE CHARGES.

The Signee agrees to pay a Finance Charge for purchases of services and goods on any part of the balance which remains unpaid beyond the GRACE PERIOD, calculated from the date of first billing. The Grace Period is variable and will range from a minimum of 28 DAYS to a maximum number of 55 days from the date of purchase depending on the date of purchase in relation to the close of the billing cycle for the month in which the purchase is made. You do not pay a Finance Charge on unpaid Finance Charges.  If you pay the "Account Balance" in full within the Grace Period, we will not charge you a Finance Charge.

The monthly periodic rate we use to calculate the Finance Charge is a MONTHLY PERIODIC RATE of ___%.  This results in an ANNUAL PERCENTAGE RATE or "APR" equal to the rate of _____% (APR).  ADJUSTED BALANCE METHOD.  We calculate the Finance Charge by applying the Monthly Periodic Rate to the Financed Amount.  We get the Financed Amount by taking the balance owed at the end of the previous billing cycle and subtract any unpaid Finance Charges and any payments and credits made on the account during the current billing cycle.  We will apply your payments and credits first to the Finance Charge and any Return Check Fees, and second to the purchases of goods and services in chronological order. Unless provided otherwise, if you have a balance subject to

Finance Charge for billing, and the amount of such Finance Charge for that billing, calculated as described above, is less than ___________ ($_____ ), a Minimum Finance Charge of _________ ($______ ) will be charged for that billing period, except where prohibited by law.

4. DEFAULT. You will be in default if you fail to pay the minimum payment agreed to when due on two occasions within any 12 month period. We have the right to declare your entire unpaid balance immediately due and payable in full if you default on your payments. Except where prohibited or limited by law, if your account is referred to an attorney (not our salaried employee) and/or a collection agency for collection, you agree to pay for any and all costs, charges and/or fees incurred in connection with the collection of the debt plus any court filing fees and attorney fees. Furthermore, delinquent accounts may be reported to the Credit Bureau‘s (Credit Reporting Agencies) and by signing this agreement you consent to the release and reporting of your personal and private information, your medical and financial information and your identification, location and contact information.

5. ASSIGNABILITY. You agree that we may assign our rights under this agreement. You may not assign your rights under this agreement without our prior written consent.

6. MISCELLANEOUS. Except where prohibited by law, you agree to pay a RETURN CHECK FEE in the amount of ____________________________($_____) plus applicable State Sales Tax, for all checks returned, based on our expenses of handling.

7. CHANGE OF TERMS. WE MAY CHANGE THE TERMS OF THIS AGREEMENT FROM TIME TO TIME IN ACCORDANCE WITH APPLICABLE LAWS. WITH A CLEAR UNDERSTANDING OF THIS OFFER, THE TERMS AND THE CONDITIONS OUTLINED ABOVE, THE PARTIES SIGNING THIS AGREEMENT DO HEREBY ENTER INTO A LEGAL AND BINDING CONTRACT. FURTHERMORE, IT IS AGREED, A COPY OF THIS AGREEMENT/CONTRACT SHALL BE AS EFFECTIVE AND VALID AS THE ORIGINAL.

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CONSUMER NAME PRINTED    CONSUMER SIGNATURE           DATE

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CREDITOR NAME PRINTED    CREDITOR SIGNATURE           DATE