Common Contracts
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COMMERCIAL PREMIUM FINANCE AGREEMENT AND DISCLOSURE STATEMENTJuly 21st, 2009
INSURED/BORROWER (Name and address as shown on Policy) A Total Premium $ B Cash Down Payment Required $ C Unpaid Premium Balance $ Telephone Number: D Documentary Stamp Tax(only applicable in Florida) $ Direct Correspondence to: E Amount Financed (The amount of credit provided on your behalf) $ AGENT or BROKER (Name and Business Address) F FINANCE CHARGE(Dollar amount credit will cost you) $ G Total of Payments (Amount you will have paid after making all scheduled payments) $ Telephone Number: ANNUAL PERCENTAGE RATE(Cost of your credit figured as a yearly rate) % PAYMENT SCHEDULE BELOW, or See Schedule Attached LENDER FIRST INSURANCE FUNDING CORP.450 Skokie Blvd, Suite 1000P.O. Box 3306 Northbrook, IL 60065-3306Telephone: (800) 837-3707Fax: (800) 837-3709 Number ofPayments Payments are due Amount of EachPayment Prepayment The Insured may prepay the full amount due and receive a refund of the unearned interest as provided on page 2 of this agreement.Security As security
