CONSUMER CREDIT APPLICATION

By filling this form you accept the terms and conditions. By signing below you (a) apply for credit; (b) agree that, to the best of your knowledge, all information contained in this application above is complete and accurate; (c) recognize that Broward Water Consultants, Inc. DBA Coastal Energy Water & Air (CEWA) may obtain consumer reports on you in connection with your application and may obtain and use subsequent reports in connection with the collection of your account, and other uses not prohibited by law; and (d) expressly authorize any third party (i.e. creditor, bank or financial institution; employer; landlord; etc.) to release whatever information is requested concerning you that CEWA may request; (e) agree that CEWA may monitor and record telephone calls regarding your account for quality assurance and for other reasons not prohibited by law; (f) expressly consent and agree to us using written, electronic or verbal means to contact you as not otherwise prohibited by law including, but not limited to, contact by manual calling methods, prerecorded or artificial voice messages, text messages, emails, and/or automatic dialing systems and do so using any email address or telephone number you provide, now or in the future, including a number for a mobile phone or other wireless device regardless of whether you may incur charges as a result; (g) acknowledge that the terms and conditions of this agreement is subject to credit approval; (h) acknowledge that Interest Charges will be imposed in amounts or rates not in excess of those permitted by law; (i) acknowledge this instrument is based upon a home solicitation sale, which is subject to the provisions of the Home Sale Disclosure law set forth under "Home Sale Disclosure Laws"; (j) grant us a purchase money security interest in any goods you purchase under this Agreement which is described in any order invoice or similar document issued by CEWA, which becomes part of this agreement; (k) acknowledge that this instrument is not negotiable; and (l) acknowledge that you are receiving the Retail Charge Agreement Additional Terms and Disclosures. The Additional Terms and Disclosures are in effect on the date of execution and incorporated herein.

Seller:

Company Name: Coastal Energy Water &Air

Address: 1394 NE 45th St. Pompano Beach. FL 33064

Sale:

Additional Terms and Disclosures

Home Sale Disclosure Laws: Home Sale Disclosure laws govern this transaction. The Home Sale Disclosure law applicable to this Agreement is determined as Florida, Fla. Stat. Ann. §§ 501.021 et seq;

No Oral Modifications: You agree that we are not bound by any oral agreements or oral modifications to this Agreement.

Credit Investigation and Reporting: You agree that we may investigate your credit in connection with the initial extension, review, or collection of your Account. You agree that we may examine employment and income records, verify your credit references, and report to the credit reporting agencies, merchants, and any other creditors the status and payment history of your Account. A negative credit report may be submitted to a credit reporting agency if you fail to fulfill the terms of your credit obligations. 

 

NOTICE TO BUYER: (a) Do not sign below this agreement before you read it or if any spaces intended for the agreed terms are left blank. (b) You are entitled to an exact copy of this Agreement at the time you sign it. (c) You may at any time pay off the full unpaid balance under this Agreement. (d) BUYER'S RIGHT TO CANCEL: You may CANCEL this transaction, without any Penalty or Obligation, within THREE BUSINESS DAYS from the below date. If you cancel, any property traded in, any payments made by you under the contract or sale, and any negotiable instruments executed by you will return within TEN BUSINESS DAYS following the receipt by CEWA of your cancellation notice, and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to CEWA at your residence, in substantially as good condition as when received, any goods delivered to you under this contract or sale, or you may if you wish, comply within the instructions of CEWA regarding the return shipment of goods at CEWA's expense and risk. If you do not make the goods available to CEWA and CEWA does not pick them up within 20 days of the date of your notice of cancellation, you may retain or dispose of goods without any further obligation. If you fail to make the goods available to CEWA, or if you agree to return the goods to CEWA and fail to do so, then you remain liable for the performance of all obligations under the contract. To cancel this transaction, mail or deliver the signed and dated Notice of Cancellation bottom portion of the Cancellation Notice that was provided at the time of sale or any other written notice, or send a fax to: Coastal Energy Water & Air at 1394 NE 48th Street, Pompano Beach, FL 33064. Fax Number (954) 933-9444.

Your signatures below mean that you have received a completely filled copy of this agreement. Keep this agreement to protect your legal rights. CAUTION-IT IS IMPORTANT THAT YOU THOROUGHLY READ THE CONTRACT BEFORE YOU SIGN IT.

 

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicants' income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Protection Act. The federal agency that administers compliance with the law concerning this law is the Federal Trade Commission, Equal Credit Opportunity, Washington DC 20580.