The purchaser of motor vehicles financed under an installment sales contract must be furnished at the time the contract is consummated with a properly executed copy of a record of the transaction in which must be incorporated the following minimum requirements: AND MORTGAGED PROPERTY

1. (a) CASH SELLING PRICE (Including Sales Tax andExtra Equipment)…………………………………………………………. $____________ Indicate Extra Equipment ……………………………………………… and Amount Sales Tax…………………………………………………. DOWN PAYMENT: CASH………………………….. $____________ TRADE-IN: Year…………………………………… Make Model………………………………………… Motor No…………………………………….. $____________
2. (b) TOTAL DOWN PAYMENT…………………………………………….. $____________
3. (c) UNPAID BALANCE OF CASH PRICE (Subtract Item b from a)………………………………………………….. $____________
4. (d) TOTAL FINANCE CHARGE AND INSURANCE PREMIUM FOR WHICH CREDIT IS EXTENDED……………………………….... $____________ Check Insurance Coverage: Comprehensive or Fire-Theft and Combined Additional Coverage $______________ Deductible Collision Term……………………………………………………………………… Months Other (Describe):…………………………………………………………………………... Class 1 – Over Age 25 Yes No Class 2 – Under Age 25 Yes No Class 3 – Business Only Yes No Health and Accident and Credit Life Insurance Creditor Life Insurance Only No Creditor Life nor Health & Accident Insurance PURCHASER MUST BE FURNISHED POLICIES ON EACH COVERAGE CHECKED ABOVE WITHIN TWENTY-FIVE (25) DAYS AFTER THIS DATE.
5. (e) DEFERRED (time) BALANCE………………………………………… $____________ Payable in ___________ Monthly Installments of $____________ each and One Final Installment of $_____________ The First Installment Becomes Due _____________, _______.
6. (f) The purchaser must indicate whether or not he(she) has fire, theft or collision insurance on trade-in car. Yes No
7. (g) If so, indicate whether you want this insurance transferred without penalty, to the car being purchased. Yes No
8. (h) If there is no trade-in involved, the borrower or purchaser must indicate his(her) desire that the seller arrange the insurance described above. Yes No
9. (i) If the answer is “No” immediately above, give name of agent through whom the insurance will be procured. ____________________ AND MORTGAGED PROPERTY I (OR WE) CERTIFY THAT I (OR WE) HAVE EXAMINED THE ABOVE STATEMENT, THAT I (OR WE) UNDERSTAND EACH INCLUDED ITEM, AND THAT A COPY OF THIS STATEMENT WAS FURNISHED ME (OR US) UPON SALE OF THE ABOVE VEHICLE.

Authority: T.C.A. §56-2-301. Administrative History: Original rule certified June 10, 1974.