Provider # _______________________________________________ 

AUTOMATIC PAYMENTS 

(cid:136) I would like to be set up for automatic monthly payments from my checking or 
     savings account (ACH). 
(cid:136) I would like to receive my monthly account statements by e-mail and have access 
     to pay my bill online. 

A representative will contact you to set up the above payment options 

By signing this application: 1) you warrant all information you provide is true and complete; 
2) you authorize Provider to assign this application to Aqua Finance, Inc. or its assigns; 3) 
you authorize a full investigation and release of any records from any source, including 
credit bureau reports, to check the accuracy of information on this application; and 4) you 
consent to receiving autodialed message calls from us or our agents on your wireless 
phone. You have a continuing duty to keep us informed if any information on this 
application changes. By completing and signing this application you understand that you 
have requested that we open a revolving credit account which allows you to make credit 
purchases on account as evidenced by a revolving credit sales slip, and you agree to all the 
terms and conditions of this Revolving Credit Agreement. By your signature you 
acknowledge that you have received and read all the terms of this Agreement before 
making any purchases on the account. IF THIS IS A JOINT ACCOUNT YOU 
UNDERSTAND THAT EACH APPLICANT HAS THE RIGHT TO USE THE ACCOUNT TO 
THE CREDIT LIMIT AND THAT CO-APPLICANTS ARE JOINTLY AND SEVERALLY 
LIABLE FOR ALL PURCHASES ON THE ACCOUNT.  See State Notices for important 
information regarding this credit application and agreement. No agreement exists 
between us until this application is approved.  
DO NOT SIGN BELOW UNLESS PROVIDER HAS PROVIDED THE ATTACHED 
DISCLOSURES AND TERMS. BY YOUR SIGNATURE BELOW YOU ACKNOWLEDGE 
RECEIPT OF THE ATTACHED REVOLVING CREDIT AGREEMENT. 
                                                                       /         / 
Applicant Signature                                                                            Date 
                                                                     /         / 
Joint Applicant Signature                                                                  Date 

NOTICE TO WISCONSIN APPLICANTS: No provision of a marital property agreement, a 
unilateral statement under Wis. Stats. §766.59, or a court decree under Wis. Stats. §766.70 
adversely  affect  the  interest  of  the  creditor  unless  the  creditor  is  furnished  a  copy  of  the 
decree,  agreement,  statement,  or  has  actual  knowledge  of  the  adverse  provision  prior  to 
the time credit is granted. You must supply us with your spouse’s name and address in the 
Spouse/Joint  Applicant  section  above  so  we  can  give  notice  of  this  credit  transaction  by 
mailing  a  copy  of  this  application.    If  you  are  married,  you  agree  that  this  obligation  is 
incurred in the interest of marriage or family.  
Applicant Signature:___________________________________________________ 
CREDIT  REPORT  NOTICE:  We  may  request  a  credit  report  for  any  legitimate  purpose 
associated  with  your  application  for  credit,  extending  credit,  modifying  the  terms  of  your 
credit agreement, or collection on your account. On your request we will inform you if such 
a report was ordered and will give you the name and address of the credit reporting agency 
that furnished the report. 
NOTICE: 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 applicant’s income derives from any public assistance program; or 
because  the  applicant  has  in  good  faith  exercised  any  right  under  the  Consumer  Credit 
Protection  Act.  The  Federal  agency  that  administers  compliance  with  the  law  concerning 
this creditor is the Federal Trade Commission. 

Delaware residents: Service charges not in excess of those permitted by law will be 
charged on the outstanding balances from month to month. 
Maryland residents: Finance charges will be made in amounts or at rates not in 
excess of those permitted by law. 

AFI-599-Variable Rate RCA 8/1/11 

Amount Financed $________________________________________ 

Your Minimum Monthly Payment will be 4% of the “Highest Monthly 
Charge” balance since your Monthly Charge Balance was zero (less 
any Special Payment Plans) as will be shown on your billing 
statement, rounded to the next highest dollar, or $15, whichever is 
greater.  A finance charge will be computed on your outstanding 
balance each month. 

In this Agreement “you” and “your” refer to all persons applying for credit 
and “we”, “us”, and “our” refer to Provider and its assigns.  
CUSTOMER CREDIT APPLICATION  

APPLICANT INFORMATION   (Please Type or Print Clearly) 

□ Own   □ Rent                                                   Mobile Home?  □ Yes   □ No 
Social Security Number                                                      Driver’s License Number    
          -        - 
First Name                                       Middle                                                    Last Name 

Home Phone Number                                                     Cell or Pager Number 
(              )                                                   (              ) 
Date of Birth                                                      E-mail address       
        /            / 
Current Address                                                                                                  Apt #  

City                                                                                   State              Zip                              

     Monthly Rent or Mortgage Payment                                        
$                                                       

APPLICANT EMPLOYMENT INFORMATION 
Present Employer                                            Self-Employed?  (cid:70) YES  (cid:70) NO 

Position                                                                How long? (month/Year) 

Business Phone                                                       Gross Monthly Income            
(                )                                                          $ 

JOINT APPLICANT INFORMATION   (cid:137) Spouse     (cid:137) Non-spouse 

Social Security Number                                                                     Driver’s License Number   
            -            - 
First Name                                       Middle                                                    Last Name 

Home Phone Number  (if different from Applicant)        Cell or Pager Number 
(                  )                                                 (                 ) 
Date of Birth                                                E-mail address                               
          /              / 
Current Address  (cid:70) Same as Applicant  (if not, please provide below)                                               

City                                                                                  State              Zip                             

Employer 

Position                                                                                             Gross Monthly Income                
                                                                                $ 
Business Phone                                                                                    How long?(Month/Year) 
(               ) 

OTHER INCOME SOURCES (family support income need not be revealed if you 
 do not wish to have it considered as a basis for repaying this obligation)  

Domestic partner/Spouse (not on application) 
Retirement/SSI 
Rental Income 
Investments 
Other (List Type:_____________________________) 

$____________________ 
$____________________ 
$____________________ 
$____________________ 
$____________________ 

PERSONAL REFERENCE (not living with you) 

Name 

Relationship                                                                      Phone Number 
                                                                     (             ) 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IMPORTANT INFORMATION ABOUT YOUR ACCOUNT 

KEEP THIS INFORMATION FOR YOUR RECORD 

REVOLVING CREDIT AGREEMENT AND 
DISCLOSURE STATEMENT 
Provider may assign all rights under this Agreement and any credit sale made pursuant to it 
(as evidenced by a revolving credit sales slip) to Aqua Finance, Inc. (AFI)   
Interest Rates and Interest Charges 
ANNUAL 
PERCENTAGE 
RATE (APR) for 
Purchases  
Paying Interest  

____%   
Your APR will vary with the market 
based on the Prime Rate. 

You will be charged interest from 
the transaction date, except in 
states that require a grace period.  
In those states, your due date is at 
least 25 days after the close of 
each billing cycle and we will not 
charge you any interest on 
purchases if you pay your entire 
balance by the due date each 
month. 
If you are charged interest, the 
charge will be no less than $0.50. 
To learn more about factors to 
consider when applying for or using 
a credit card, visit the Federal 
Reserve Board’s website at 
www.federalreserve.gov/creditcard. 

Minimum Interest 
Charge 
For Credit Card 
Tips from the 
Federal Reserve 
Board  

Fees  
Fees Vary By State 
Penalty Fees 
Up to $35 See paragraph 11 of Agreement 
•Late Payment  
Up to $30 See paragraph 12 of Agreement 
•Returned Payment  
How We Will Calculate Your Balance: We use a method called the 
“Average Daily Balance (including new purchases).”  See your account 
Agreement for more details. 
Billing Rights: Information on your rights to dispute transactions and 
how to exercise those rights is provided in your account agreement. 
This  information  is  accurate  on  the  date  of  your  completed 
application and initial purchase.  If any of this information changes 
you will be notified at least 45 days prior to any change and how to 
contact us regarding any change.  All terms are subject to change. 

1. GENERAL:  If your credit application is approved and we open a revolving credit account 
for  you,  you  may  purchase  goods  and  services  on  credit  from  the  Provider  where  you 
opened  your  account.    Purchases  are  pursuant  to  a  revolving  credit  sales  slip  and  you 
agree that all sales are subject to the terms of this Agreement.  You and the Provider, and 
no  other  party,  will  determine  the  scope  and  kind  of  services  you  purchase  under  this 
Agreement.  Only the Provider will have access to, retain, and maintain all of your medical 
records.  Medical information is not requested or used by us to determine your eligibility for 
credit or continued credit except as allowed by law. 

2.  PROMISE  TO  PAY:    You  agree  to  pay  for  all  purchases  made  on  your  account, 
FINANCE CHARGES, and other applicable charges or fees under this Agreement incurred 
by  you  or  anyone  you  authorize  or  permit  to  use  your  account.  If  this  account  is  a  joint 
account,  each  joint account  holder  agrees  to  pay,  and  all  account  holders  are  jointly  and 
severally responsible for all amounts owed on the account. If your account is referred for 
collections to an attorney who is not our salaried employee, you agree to pay reasonable 
attorney fees and reasonable collection costs to the extent allowed by law in your state. If 
your  state  does  not  allow  attorney  fees  (IA,  ME,  OH,  and  WI),  you  agree  to  pay  any 
statutory attorney fees and costs that may be awarded to us by a court of law.  

3. CREDIT LIMIT:  We set a credit limit on your account which we may modify at any time 
for  any  reason  not  prohibited  by  law.  You  may  not  charge  purchases  if  it  causes  you  to 

exceed your credit limit unless we allow such purchases. You agree to pay all amounts over 
your credit limit. 

4. BILLING STATEMENT:  We will mail you a statement each month you have an account 
balance greater than $1.00 at the address we have in our records. This statement will show 
credit  purchases,  late  charges,  NSF  fees,  previous  balance,  new  balance,  payments 
received,  credits,  FINANCE  CHARGES,  total  minimum  payment  due,  and  payment  due 
date. 

5.  MINIMUM  MONTHLY  PAYMENT:    All  payments,  except  disputed  payments,  must  be 
mailed  or  delivered  to  the  Payment  Processing  Center  address  shown  on  your  monthly 
billing statement. All payments must be made by electronic fund transfer, check or money 
order.  Do  not  send  cash.  Cash  or  other  nonconforming  methods  of  payment  may  by 
rejected.  We  may  accept  partial  or  late  payments  or  checks  marked  “payment  in  full”  or 
other restrictive endorsement without losing our right to receive the full amount owed. Your 
billing statement will include requirements for you to follow in making payments. Disputed 
payments, including those which indicate that the payment constitutes “payment in full” of 
the  amount  owed,  must  be  mailed  or  delivered  to  the  Customer  Service  address  listed 
below. You agree to pay us at least the Total Minimum Monthly Payment reflected on your 
statement. You may pay more than the Total Minimum Monthly Payment and you may pay 
the entire amount due at any time.  The Total Minimum Monthly Payment Due shown on 
your billing statement will be the sum of the Minimum Monthly Payment plus all past due 
amounts, late fees, and other charges.  The Minimum Monthly Payment is calculated at the 
end of the first month in which you make a purchase, and will be calculated each month in 
which you make an additional purchase.  Your Minimum Monthly Payments will be 4% of 
the “Highest Monthly Charge” balance since your Monthly Charge Balance was zero, less 
any Special Payment Plans as shown on your billing statement rounded to the next higher 
dollar, or $15, whichever is greater, unless your account balance is less than $15 in which 
case the Minimum Monthly Payment will be equal to the account balance. You agree that 
any  payment  may  be  returned  if  your  check  is  (i)  not  drawn  in  U.S.  dollars  on  funds  on 
deposit  in  the  U.S.;  (ii)  missing  a  signature;  (iii)  drawn  with  different  numeric  and  written 
amounts;  (iv)  contains  a  restrictive  endorsement;  (v)  postdated;  or  (vi)  not  paid  on 
presentment. 

6. ELECTRONIC FUND TRANSFER:  When you provide a check, you authorize us either 
to use information from your check to make a one-time electronic fund transfer from your 
account or to process the transaction as a check.  When we use your check to make an 
electronic fund transfer, funds may be withdrawn from your account as soon as the same 
day we receive your payment, and you may not receive your check back from your financial 
institution. If there are insufficient funds in your account you authorize us to charge an NSF 
Fee  as  indicated  below  and  collect  that  amount  through  an  electronic  fund  transfer  from 
your account. 

7. PREPAYMENT:  You may pay your entire account balance at any time without penalty.  
If you do not pay the entire balance in full, you must make a minimum payment each month 
by the payment due date that appears on your billing statement. Under federal law, we are 
not required to refund any amounts less than $1.00. 

8. FINANCE CHARGE:  FINANCE CHARGES begin the date a purchase is posted to your 
account  and  accrue  as  long  as  your  account  has  a  balance,  except  in  states  with  a 
mandatory grace period.  The FINANCE CHARGE is computed by applying a daily periodic 
rate  of  .______  %  (corresponding  to  an  annual  percentage  rate  of  ___%)  to  the  daily 
balance.    The  daily  balance  is  calculated  by  taking  the  beginning  balance  in  the  account 
each day, adding any new charges and subtracting payments and credits. The FINANCE 
CHARGE is calculated by (i) taking each daily balance, (ii) multiplying that daily balance by 
the applicable daily periodic rate, (iii) adding together the resulting amounts for each day in 
the billing cycle.  The total periodic FINANCE CHARGES for the billing cycle is the sum of 
the periodic FINANCE CHARGES for each purchase type rounded to the next highest cent.  
Any Daily Balance less than zero will be treated as zero.  A minimum FINANCE CHARGE 
of no less than $0.50 is added to your account in any billing cycle your account is subject to 
a FINANCE CHARGE, except in states where prohibited by law.  The grace period is 25 
days  in  Louisiana,  Maine,  Maryland,  Massachusetts,  Mississippi,  North  Carolina,  and 
Virginia  and  30  days  in  Nebraska  and  Vermont  on  new  purchases  where  you  account 
balance is $0 or you have paid your previous balance due in full by the end of the billing 
cycle.  

9. DEFAULT:  You are in default if: (a) you fail to make a required payment when due on 
two occasions in any 12 month period; (b) you fail to observe or perform any of the other 
covenants  or  duties  contained  in  this  Agreement  if  the  failure  materially  impairs  the 
condition, value or protection of our right in any Collateral, or materially impairs your ability 
to pay any amounts on your billing statement when due. You will receive a Notice of Right 
to Cure in the following states: Colorado, Iowa, Kansas, Maine, Massachusetts, Nebraska, 
Pennsylvania,  and  Wisconsin.  If  you  fail  to  cure  within  the  time  allowed  in  your  notice  or 
within  30  days  if  you  live  in  a  state  with  no  notice  requirement,  we  may  accelerate  your 
balance. 

10.  VARIABLE  RATE  DISCLOSURES:    The  Annual  Percentage  Rate  (“APR”)  on  your 
account may increase or decrease.  The APR may change every month.  There is no limit 
on the amount that the APR may increase or decrease, except as may be limited by law.  
An index and margin are used to figure your APR.  The index used to figure the APR is the 
highest prime rate published in the “Money Rates” section of the Wall Street Journal as of 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
the 25th day of the previous month.  In the event the prime rate is not published on the 25th 
of the month, the prime rate published most recently prior to that date will be used.  The 
APR is determined by adding ___.___% to the index.  APR changes will take effect on the 
first  day  of  the  billing  cycle  that  begins  on  or  after  the  first  day  of  the  month  following  a 
change in the index. 

11.  LATE  FEE:    If  your  payment  is  more  than  10  days  late  (15  days  in  Maine, 
Massachusetts, Idaho, or South Dakota), you may be charged a late fee up to the amount 
indicated  below  for  your  state  of  residence.    The  late  fee  will  be  added  to  your  account 
balance. 

(KS & MO if payment due is less than $25) 
AK, AR, CA, FL, KS, MO, MT, NJ, OH, RI, SD, TN   
CO, IN, IA, MS, NV, NH, NY, ND, OR, VT, WA, WI 
GA 
MN -$7.28 maximum; NC -$6 maximum 
AL, KY & WY -$10 minimum; 
ID & MI -$15 minimum; 
HI, VA 
UT 
NE 
OK ($5 minimum), TX, D.C. 
AZ, CT,IL, LA, MD, ME 
NM, PA, SC 
MA 

5% of payment due; 
5% of payment due; 
5% of payment due; 
5% of payment due; 
5% of payment due; 
10% of payment due; 

5% of payment due;  

$5 
$10 
$15 
$25 
5% of payment due 
$35 maximum* 

$30 maximum* 
$25 maximum 
$15 maximum 
$10 maximum 
$5 maximum 
$10 maximum 

*($25 maximum-first occurrence in more than 6 months.) 

12.  RETURNED  PAYMENT  /  NSF  FEE:    If  any  payment  instrument  or  method  is 
dishonored  by your  bank  or  the  drawee,  you  agree  to  pay  an  NSF  fee  up  to  the  amount 
indicated  below  for  your  state  of  residence.    If  required  by  your  state,  you  will  receive  a 
notice with instructions about the NSF service or collection fees, and if you fail to pay the 
fee  we  will  add  it  to  your  account  balance.    We  are  not  required  to  present  payment 
instruments  more  than  once  to  the  drawee  for  payment.  This  fee  will  be  added  to  your 
account balance.  

MA, ME, AZ (greater of $10 or bank fee) 
CA, MS, MO 
CT, D.C., ID, IA, MN, NJ, NY, OH, PA, UT, VT 
AR, CO, FL, IL, IN, KY, LA, MI, NV, NH, NM, NC, OK, OR, RI, TX, WI  
AL, AK, GA, HI, KS, MT, ND, SC, SD, TN, VA, WA 
*($25 maximum-first occurrence in more than 6 months.) 

$10 
$15 
$20 
$25 
$30* 

13.  ACCOUNT  INFORMATION:    You  authorize  us  to  furnish  information  about  your 
account  to  credit  reporting  agencies  and  anyone  else  who  may  lawfully  receive  such 
information.    On  request,  you  agree  to  promptly  provide  us  with  accurate  and  updated 
financial and employment information.  You agree to give us prompt notice of any change in 
your  name,  address,  and  telephone  numbers.  Where  allowed  by  law,  you  authorize  the 
Department  of  Motor  Vehicles  to  release  your  address  if  it  becomes  necessary  to  locate 
you. 

14.  SPECIAL  CREDIT  PROMOTION  PLANS:  We  may  occasionally  offer  special  credit 
promotion plans for you to participate in at your option. 

15. CHANGE IN TERMS:  We may change the terms of this Agreement, as permitted by 
law, at any time.  You will be notified of changes in accordance with applicable state and 
federal law, but in the event your state does not specify a time period, you will be notified at 
least 45 days in advance of any such changes, and such notice will be sent to your current 
address as shown on our records for your account.  We count the days from the date we 
mail the notification.  

16.  CREDIT  INVESTIGATION:    You  agree  we  may  investigate  your  credit,  employment, 
and financial status.  You authorize us to obtain a credit report and any other information 
about  your  creditworthiness  in  connection  with  processing your  application  for  credit,  and 
subsequently in connection with any extension of credit, request to increase credit limits, or 
any  renewal  or  update  of  your  account,  or  to  take  collection  action  on  the  account,  or  to 
investigate  disputes  regarding  the  account.  At  your  request,  we  will  inform  you  if  such 
reports  were  ordered,  and  the  names  of  the  credit  bureaus  that  provided  reports.  You 
authorize the Department of Defense and its various departments and commands to verify 
your  social  security  number  or  other  identifier  and  disclose  your  home  address  to  the 
authorized  holder  of  this  Agreement  for  purposes  of  performing  or  enforcing  the  terms  of 
this  Agreement.  You  authorize  any  past  or  present  employer  to  confirm  employment  or 
communicate with us regarding your indebtedness to us if you fail to meet the terms and 
conditions  of  this  Agreement.  We  use  information  furnished  solely  in  connection  with 
performing or enforcing the terms of this Agreement.  

17. ACCOUNT CANCELLATION:  We may cancel your account at any time for any reason 
subject  to  the  requirements  of  applicable  law.    Outstanding  balances  continue  to  accrue 
FINANCE CHARGES until paid in full, and remain subject to all terms and conditions of this 

Agreement.  You may cancel your account by writing to our account service provider Aqua 
Finance, Inc., P.O. Box 844, Wausau, WI 54402-0844. Your notice is effective on receipt. If 
you  cancel  your  Account,  you  are  still  responsible  for  all  amounts  owed  pursuant  to  the 
terms of this Agreement.  

18.  ASSIGNMENT:    This  Agreement  is  not  effective  until  your  application  has  been 
approved  by  us  or  AFI.    We  have  the  right  to  assign  any  or  all  of  our  rights  under  this 
Agreement to any assignee of our choosing.  You may not assign this Agreement or any 
rights  under  it  and  any  attempt  to  make  such  an  assignment  will  be  null  and  void.  You 
understand that Provider and AFI are independent entities and not employees or agents of 
one  another.    This  Agreement  legally  binds  the  parties  and  their  respective  heirs, 
representatives, executors, administrators, successors and assigns.   

19. SEVERABILITY:  If any provision of this Agreement is deemed void or unenforceable 
under any law, rule, or regulation, all other provisions remain in effect and enforceable. 

20.  NON-WAIVER:    We  do  not  lose  any  of  our  rights  under  this  Agreement  if  we  delay 
taking action for any reasons. 

21.  REPRESENTATION:    You  swear  that  all  the  information  you  supplied  on  your  credit 
application  and  all  the  information  on  each  revolving  credit  sales  slip  is  and  will  be  true, 
correct, and accurate.  Any false, incorrect, or misleading information you knowingly supply 
is a deliberate misrepresentation.  

22.  STATE LAW RESIDENT NOTICES: 
CALIFORNIA STATE NOTICE: Applicants may 1) use the credit account 
up  to  its  credit  limit  after  credit  approval;  2)  be  liable  for  amounts 
extended  under  the  plan  to  any  joint  applicant.  A  negative  credit  report 
reflecting  on  your  credit  record  may  be  submitted  to  a  credit  reporting 
agency if you fail to fulfill the terms of your credit obligations. 
COLORADO  RESIDENTS:  Warning:  The  terms  of  this  revolving  charge  account  may  be 
changed, whether or not authorized by agreement, in accordance with the Colorado UCCC 
and other applicable law. 
DELAWARE: Service charges not in excess of those permitted by law will be charged on 
the outstanding balances from month to month. 
ILLINOIS:  No  applicant  may  be  denied  a  credit  card  on  account  of  race,  color,  religion, 
national origin, ancestry, age (between 40 and 70), sex, marital status, physical or mental 
handicap unrelated to the ability to pay or unfavorable discharge from military service. The 
applicant may request the reason for rejection of his or her application for a credit card. No 
person need reapply for a credit card solely because of a change in marital status unless 
the change in marital status has caused deterioration in the person’s financial position. A 
person may hold a credit card in any name permitted by law that he or she regularly uses 
and is generally known by, so long as no fraud is intended thereby. 
MAINE: We may request a consumer report in connection with your application for credit. 
You may ask whether a consumer report was obtained by us and we will tell you the name 
and address of the consumer reporting agency, if a report was obtained. Charges incurred 
by use of your card are due and payable on receipt of your monthly statement. 
MARYLAND: Finance charges will be made in amounts or at rates not in excess of those 
permitted by law. You may pay the entire balance at any time without incurring additional 
charges for prepayment.  
VERMONT:  We  may  obtain  your  credit  reports  at  any  time,  for  any  legitimate  purpose 
associated with the account or the application or request for an account, including but not 
limited to reviewing, modifying, renewing and collecting on your account. On your request 
we  will  inform  you  if  such  a  report  was  ordered.  If  so,  we  will  give  you  the  name  and 
address of the consumer reporting agency furnishing the report.  
OHIO: Ohio anti-discrimination laws require creditors to make credit equally available to all 
creditworthy customers and that credit reporting agencies maintain separate credit histories 
on individuals upon request. The Ohio Civil Rights Commission administers these laws. 
TEXAS: To contact Aqua Finance, Inc. about this account call 715-848-5425.  This contract 
is  subject  in  whole  or  in  part  to  Texas  law  which  is  enforced  by  the  Consumer  Credit 
Commissioner, 2601 N. Lamar Blvd., Austin, Texas 78705. Phone 512-936-7600. Contact 
the commissioner relative to any inquiries or complaints.  

23.  SECURITY AGREEMENT: You grant us a purchase money security interest under the 
Uniform Commercial Code in each good purchased on account to the full extent permitted 
by  law.    To  the  extent  allowed  by  law,  you  will  pay  all  official  fees  and  taxes,  and  on 
request,  take  any  reasonable  action  requested  by  us  to  preserve  the  collateral  or  to 
establish, determine priority of, perfect, continue perfected, terminate or enforce our interest 
in it or rights under this agreement. If you do not make payments as agreed, this security 
interest allows us to take actions in accordance with state laws governing the enforcement 
of security interests in collateral. You further agree to keep the goods at the address on the 
credit  application  and  to  not  remove  or  materially  alter  them  without  our  written  consent.  
You  may  lose  the  goods  you  purchased  if  you  do  not  meet  your  obligations  under  this 
agreement. 

24. NOTICE: 

ANY HOLDER OF THIS CONSUMER CREDIT CONTRACT IS 
SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE 
DEBTOR COULD ASSERT AGAINST THE SELLER OF 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• 

If we did not believe there was a mistake: You will have to 
pay the amount in question along with applicable interest 
and fees. We will send you a statement of the amount 
you owe and the date payment is due.  We may then 
report you as delinquent if you do not pay the amount we 
think you owe.   

If you receive our explanation but still believe your bill is wrong, 
you may write to us within 10 days telling us that you still refuse to 
pay. If you do so, we cannot report you as delinquent without also 
reporting that you are questioning your bill.  We must tell you the 
name of anyone to whom we reported you as delinquent, and we 
must let those organizations know when the matter has been 
settled between us.  
If we do not follow the rules above, we cannot collect the first $50 
of the amount you questioned amount, even if your bill was 
correct. 

Your Rights If You Are Dissatisfied With Your Credit Card 
Purchases 

If you are dissatisfied with the goods or services that you have 
purchased with your credit card, and you have tried in good faith to 
correct the problem with the Provider, you may have the right not 
to pay the remaining amount due on the purchase.  To use this 
right, all of the following must be true: 

1.  The purchase must have been in your home state or within 
100 miles of your current mailing address, and the purchase price 
must have been more than $50.  (Note:  Neither of these are 
necessary if your purchase was based on an advertisement we 
mailed to you, or if we own the company that sold you the goods 
or services). 
2.  You must have used your credit card for the purchase.  
Purchases made with cash advances from an ATM or with a check 
that accesses your credit card account do not qualify. 
3.  You must not yet have fully paid for the purchase. 

If all of the criteria above are met and you are still dissatisfied with 
the purchase, contact us in writing at: 

Aqua Finance, Inc.   
ATTN: Customer Billing 
One Corporate Drive, Suite 300  
Wausau, WI 54401 

Note to all Buyers: Finance Charges will be made in amounts or at 
rates not in excess of those permitted by law.  You have the right to 
pay in advance the full amount due. 
NOTICE TO BUYER: 1) DO NOT SIGN ANY PART OF 
YOUR REVOLVING CREDIT AGREEMENT BEFORE YOU 
READ IT OR IF IT CONTAINS ANY BLANK SPACES. 2) 
YOU ARE ENTITLED TO A COMPLETELY FILLED IN 
COPY OF ANY AGREEMENT WHEN YOU SIGN IT. 3) A 
FINANCE CHARGE WILL BE COMPUTED ON THE 
OUTSTANDING BALANCE EACH BILLING PERIOD IN 
ACCORDANCE WITH THE RATES ABOVE. 4) YOU MAY 
PAY YOUR TOTAL UNPAID BALANCE AT ANY TIME. 

Provider Name: _________________________________________ 

Address: ______________________________________________ 

______________________________________________________ 

AFI-599-Variable Rate RCA 8/1/11 

GOODS OR SERVICES OBTAINED PURSUANT TO THIS 
AGREEMENT OR WITH THE PROCEEDS FROM IT.  
DEBTOR’S RECOVERY UNDER THIS AGREEMENT MAY NOT 
EXCEED THE AMOUNT OF CREDIT OUTSTANDING.  

Arizona residents - You must give us notice of your claim or defense in writing by certified 
mail within 90 days of receiving any goods or you may waive the right to set-offs or defense 
against assignee if assignee provides you a notice of your rights and you fail to exercise 
those rights pursuant to the terms of the notice.  Iowa residents - You must give assignee 
notice  within  30  days  of  assignment  to  assert  claims  and  defenses  against  assignee.  
Oklahoma  &  South  Dakota  residents  -  You  waive  the  right  to  bring  a  claim  or  defense 
against assignee if assignee provides you a notice of your rights and you fail to exercise 
those rights pursuant to the terms of the notice.  Wisconsin residents - You waive the right 
to  bring  a  claim  or  defense  against  assignee  after  12  months  if  assignee  provides  you  a 
notice of your rights to do so and you fail to exercise those rights pursuant to the terms of 
the  notice  of  assignment.    This  waiver  is  in  accordance  with  section  422.407  (4)  of  the 
Wisconsin Consumer Act.   Wyoming residents - You waive the right  to bring a  claim or 
defense against assignee for 45 days after assignment if assignee provides you a notice of 
your rights and you fail to exercise those rights pursuant to the terms of the notice. 
25. CUSTOMER SERVICE:  Direct all inquiries concerning your account to:   
Aqua Finance, Inc., P.O. Box 844, Wausau, WI 54402-0844 
or call Customer Service at telephone number 800-234-3663. 

26.  BILLING RIGHTS NOTICE:   

Your Billing Rights: Keep this Document for Future Use 

This notice tells you about your rights and our 
responsibilities under the Fair Credit Billing Act. 

What To Do If You Find A Mistake On Your Statement   

If you think there is an error on your statement write us at:   

     Aqua Finance, Inc.   
     ATTN: Customer Billing 
     One Corporate Drive, Suite 300  
     Wausau, WI 54401 

In your letter, give us the following information: 

•  Account Information: Your name and account number. 
•  Dollar Amount: The dollar amount of the suspected error. 
•  Description of Problem: If you think there is an error on 

your bill, describe what you believe is wrong and why you 
believe it is a mistake. 

You must contact us:  

•  within 60 days after the error appeared on your 

statement.   

•  At least 3 business days before an automated payment is 
scheduled if you want to stop payment on the amount you 
think is wrong. 

You must notify us of any potential errors in writing. You may call 
us, but if you do we are not required to investigate any potential 
errors and you may have to pay the amount in question.  

What Will Happen After We Receive Your Letter 

When we receive your letter, we must do two things:  

1. Within 30 days of receiving your letter, we must tell you that we 
received your letter. We will also tell you if we have already 
corrected the error. 
2.  Within 90 days of receiving your letter, we must either correct 
the error or explain to you why we believe the bill is correct. 

While we investigate whether or not there has been an error: 

•  We cannot try to collect the amount in question, or report 

• 

you as delinquent on that amount.   
The charge in question may remain on your statement, 
and we may continue to charge you interest on that 
amount. 

•  While you do not have to pay the amount in question, you 

are responsible for the remainder of your balance. 
•  We can apply any unpaid amount against your credit 

limit. 

After we finish our investigation, one of two things will 
happen: 

• 

If we made a mistake:  You will not have to pay the 
amount in question or any interest or other fees related to 
that amount.