Amount Financed 2. Finance Charge 3. Monthly Rate 4. Total Amount of Payments

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Pawn Agreement & Disclosure

Dated: ________________
Transaction number: ___________________
Customer’s Name: _______________________________
Address: _______________________________________

1. Amount Financed
2. Finance Charge
3. Monthly Rate
4. Total amount of payments

PAYMENT TERMS:

This loan is payable in _______ payments.

Security interest. This loan is secured by a pledge of personal property described as follows:

The pledge will remain in the possession of pawnbroker until this loan is determined. In the
event the customer has not paid in full the Total of Payments indicated above within
__________ months, or this loan has not been renewed within such period of time as provided
for below, the pledge described herein may be forfeited and sold.

PREPAYMENT OF LOAN:
Customer may prepay without penalty the unpaid balance of this loan..

THIS PAWN TICKET MUST ACCOMPANY ALL PAYMENTS. Notify pawnbroker at once if this
ticket is lost.

CUSTOMER HEREBY ACKNOWLEDGES RECEIPT OF A COPY OF THIS STATEMENT.

_________________________

Customer

_________________________

Pawn Broker

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