Georgia Code Title 10. Commerce and Trade § 10-1-689

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 includes 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: ____________________