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 4/3/12 

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            Issue Date            Expiration Date 
          -        - 
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            Issue Date            Expiration Date 
          -        - 
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 posting 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 
Consumer Financial Protection 
Bureau’s website at 
http://www.consumerfinance.gov/learnmore. 

Minimum Interest 
Charge 
For Credit Card 
Tips from the 
Consumer 
Financial 
Protection Bureau 
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 
“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, 
INTEREST  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.  

time for any reason not prohibited by law. You may not charge purchases if it causes 

3. CREDIT LIMIT:  We set a credit limit on your account which we may modify at any  

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,  INTEREST  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. INTEREST CHARGE:  INTEREST 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  INTEREST  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  purchases  and  subtracting  any  unpaid  interest  or 
other  finance  charges  and  any  payments  and  credits.  The  INTEREST  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  INTEREST  CHARGES  for  the  billing  cycle  is  the 
sum of the periodic INTEREST CHARGES for each purchase type rounded to the next 
highest  cent.    Any  Daily  Balance  less  than  zero  will  be  treated  as  zero.    A  minimum 
INTEREST CHARGE of no less than $0.50 is added to your account in any billing cycle 
your account is subject to an INTEREST CHARGE, except in states where prohibited 
by  law.    The  grace  period  is  25  days  in  Louisiana,  Maine,  Maryland,  Massachusetts, 
Mississippi,  North  Carolina  &  Virginia,  and  30  days  in  Nebraska  &  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.  No NSF fee will be charged if your state of 
residence is Delaware, Maryland, Nebraska, or Wyoming.  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.  

conditions of this Agreement.  You may cancel your account by writing to our account  

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 INTEREST CHARGES until paid in full, and remain subject to all terms and  

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 
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. 
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 

While we investigate, the same rules apply to the disputed amount 
as discussed above.  After we finish our investigation, we will tell 
you our decision.  At that point, if we think you owe an amount and 
you do not pay, we may report you as delinquent. 

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 4/3/12