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This is a written agreement between LHR Finance and

Name *

referred herein as customer. This agreement will be put in effect once the customer’s signature is recorded at the bottom of this agreement. LHR Finance agrees to lend customer $720 for a period of 6 months. The customer agrees to repay the loan back to LHR Finance in bi-weekly/monthly installments of $60.00/$120.00 as indicated below. The customer agrees to allow LHR Finance to draft the 12 bi-weekly payments of $60.00 or 6 monthly payments of $120, directly from customer’s debit or credit card as indicated on the following dates. The first down payment of $79 will be collected by Sterling Credit Group after consulting, reviewing, verifying information and ordering credit reports.

Enter Payment Details and Draft Dates

IMPORTANT: Payment will NOT be processed until we verify the information on your application, set up your file and order your 3 credit reports.

$79 Down Payment Date *

Credit or Debit Card: *

Type of card (select one)

Name on Card *

Credit Card Number *

Expiration *

Billing Zip Code *

CVV Code *

Dates to draft:

IMPORTANT: For 12 bi-weekly payments, you must complete all 12 payment dates below. For 6 monthly payments, complete only the first 6 payment dates below.

1st Payment Date *

2nd Payment Date *

3rd Payment Date *

4th Payment Date *

5th Payment Date *

6th Payment Date *

7th Payment Date

8th Payment Date

9th Payment Date

10th Payment Date

11th Payment Date

12th Payment Date

Customer Information:

Name *

Social Security Number *

Date of Birth *

Home Phone *

Cell Phone

Address *

Country

City

State

Zip code

Email *

Name, phone number and relationship of two relatives not living with you:

Relative 1 Name and Relationship *

Relative 1 Phone *

Relative 2 Name and Relationship *

Relative 2 Phone *

I authorize Sterling Credit Group and LHR Finance to charge/ debit my account for the selected service for the amounts and dates shown.

Customer’s Signature *

Date *

Referring Agent/Affiliate: