Date: ............................................................................ (date on which contract is entered into) |
Place: ............................................................................. (place where contract is entered into) |
.................................................................................... (name of merchant) |
.................................................................................... |
.................................................................................... |
(address of merchant) |
.................................................................................... (where applicable, technological address of merchant) |
.................................................................................... (Where applicable, the merchant’s permit number) |
.................................................................................... (name of consumer) |
.................................................................................... |
.................................................................................... (address of consumer) |
1. Amount up to which the credit is granted | $........... | |
2. Membership or renewal fees or fees for the replacement of a lost or stolen credit card | $........... | |
3. The length of each period for which a statement of account is provided | ............... | |
4. Minimum periodic payment or method of calculating that payment ……………………………………………………………………………………… | ||
5. Period during which the consumer may discharge the obligation without being compelled to pay credit charges ............................................................................... | ||
6. Credit rate | =========== % | |
(Where applicable, mention the nature of any optional contracts, the charge for such contracts, or how it is determined and that the consumer has a right of resiliation with respect to such contracts.) | ||
(Where applicable, mention the existence and the subject matter of any security given by the consumer to guarantee the performance of the consumer’s obligations.) | ||
Telephone number that the consumer can use, at no charge, to obtain information about the contract in the language of the contract (if not, clearly state that collect calls are accepted) ................................... |