Financing Estimate and Disclosure

Notice to Property Owner: Existing law requires that a printer paper copy of this document be provided to you before reviewing and signing, unless you opt out, in writing, to that printed copy by signing a printed paper document. If you opt out of receiving a printed paper copy of this disclosure, an electronic copy will be provided to you. The financing arrangement described below will result in an assessment against your property which will be collected along with your property taxes and will result in a lien on your property. You should read and review the terms carefully, and if necessary, consult with a tax professional or attorney.

Customer Service Toll-Free telephone number and email:

In the event you have a consumer complaint, questions about your financing obligations related to the contractual assessment or your contractual rights under the terms of this contract, you can contact either this toll-free telephone number or email address provided below and receive a response within 24 hours or one business day.

Toll-Free telephone number: ___________

Customer service email address: ___________

Products and Costs

Product costs (including

labor/installation)

$________

Description

1.

2.

3.

Financing Costs

Application fees and costs

Prepaid Interest

Other Costs

Total Amount Financed

$________

$________

$________

$________

Annual Percentage Rate (APR)

Simple Interest Rate

Total Annual Principal, Interest, and

Administrative Fees

 ______%

 ______%

$______

Note: If your property taxes are paid through an impound account, your mortgage lender may apportion the amount and add it to your monthly payment.

See “Other Important Considerations” below

Total Amount you will have paid over the life of the financing

$________

Other Costs

Appraisal Fees

Bond related costs

Annual Administrative fees

Estimated closing costs

Credit Reporting Fees

Recording Fees

$________

$________

$________

$________

$________

$________

Total Financing Costs and Closing Costs

$________

Estimated Cash (out of pocket) to close

$________

Other Terms

Prepayment fee

? No

? Yes ______

Additional Information About These Financing

Comparisons[Use this information to compare to other financing options]

Over the term of the financing

$________ Principal you will have paid off.

$________ Amount of interest you have paid.

$________ Amount of financing and other costs

you will have paid.

$________ Total you will have paid.

Annual Percentage Rate

______%

Total Interest Paid (as a percentage of all the payments you have made)

______%

Other Important Considerations

I understand that I may be required to pay off the remaining balance of this obligation by the mortgage lender refinancing my home. If I sell my home, the buyer or their mortgage lender may require me to pay off the balance of this obligation as a condition of sale.

_____ _______________

_____ [Borrower initials]

Monthly Mortgage Payments

_____ _______________

_____ [Borrower initials]

Tax Benefits: Consult your tax adviser regarding tax credits, credits and deductions, tax deductibility, and other tax benefits available. Making an appropriate application for the benefit is your responsibility.

_____ _______________

_____ [Borrower initials]

Statutory Penalties: If your property tax payment is late, the amount due will be subject to a 10% penalty, late fees, and 1.5% per month interest penalty as established by state law, and your property may be subject to foreclosure.

_____ _______________

_____ [Borrower initials]

Three Day Right to Cancel

You, the property owner, may cancel the contract at any time on or before midnight on the third business day after the date of the transaction to enter into the agreement without any penalty or obligation. To cancel this transaction, you may mail or deliver a signed and dated copy of the contract with notice of cancellation to:

___________ [name of business] at

___________ [address]

You may also cancel the contract by sending notification of cancellation by email to the following email address: _________________[email address of business].

_____ _______________

_____ [Borrower initials]

Confirmation of Receipt

This confirms the receipt of the information in this form. You do not have to accept this financing just because you acknowledge that you have received or signed this form, and it is NOT a contract.

__________________________

[Property Owner Signature – Date]

__________________________

[Property Owner Signature – Date]