Itemization of Gross Capitalized Cost

A. The agreed-upon value of vehicle.................................$_______________(A)

B. Add On Accessories and Optional Equipment..............$_______________(B)

1._______________________.......$_____________
2._______________________.......$_____________
3._______________________.......$_____________

C. Insurance.......................................................................$_______________(C)

1._______________________.......$_____________
2._______________________.......$_____________

D. Service Contracts..........................................................$_______________(D)

1._______________________.......$_____________
2._______________________.......$_____________

E. Optional Debt Cancellation Agreement..........................$_______________(E)

F. Prior credit/lease balance..............................................$_______________(F)

G. Other..............................................................................$_______________(G)

1._______________________.......$_____________
2._______________________.......$_____________

H. Document Preparation....................................................$_______________(H)

I. Optional DMV Electronic Filing Fee.................................$_______________(I)

Gross Capitalized Cost. . . . . . . . . . . . . . . . . . . . . . . .$_______________

Vehicle Insurance:

I agree to buy and maintain during the lease term,

and until the vehicle is returned to you, insurance on the Vehicle which has the following minimum coverages:
1. Public Liability for $____________________________
2. Property Damage for $__________________________
3. Collision for actual value with a maximum deductible of $____________
4. Comprehensive, including fire and theft, for actual value with a maximum     deductible of $_____________
I understand that the policy must provide you with primary coverage as an additional insured on Items 1 and 2 and as a loss payee on Items 3 and 4.

Ǥ I elect to purchase the required insurance for $ _______________ for     _____ months from you.
Ǥ I will by the insurance from an insurance company which is acceptable to you and will furnish you with whatever written proof of coverage you may request.

GAP LIABILITY NOTICE

In the event of theft or damage to the vehicle that results in a total loss, there may be a GAP between the amount due upon early termination and the proceeds of your insurance settlement and deductible. THIS LEASE PROVIDES THAT YOU ARE LIABLE FOR THE GAP AMOUNT. Optional coverage for the GAP amount may be offered for an additional price.

Ǥ I elect to purchase GAP insurance for $ _______________