Cell Phone A Regional

Extension Form, **

Branch & Customer Information

Branch Number: 324

Branch Location: Gastonia, NC

Account Number: 100*******

Borrower: John Sharpe

Co-Borrower:

Work Item Information

Form Id: 50188925

Launched By: Zina

Launched On: 8/16/2024

Form Body

Extension Period: 90-day Extension Charge: $0.00

Reason for requesting extension: Loss of Job

Are you willing to pay for this vehicle?YES

Are you currently employed full time?YES

In your current financial situation, do you have the ability to make this car payment monthly?YES After the extension, your next payment will be due on: 08/22/2024 Installments being extended: 07/2024, 06/2024, 05/2024 Your last scheduled payment is now due on: 12/22/2028 Finance charges will continue to accrue on the unpaid balance at the contract rate. By extending one or more installments, you will pay more finance charges than originally disclosed. NOTE: If My/Our Account is a Texas Retail Installment Contract, the following notice applies: Finance charges will continue to accrue on the unpaid balance at the contract rate. By deferring one or more installments, you will pay more finance charges than originally disclosed.

FAX THE COMPLETED FORM TO: 888-***-**** / No cover sheet required I/We understand that by granting the extension, Regional Acceptance Corporation (RAC) is allowing me/us to postpone the payment(s) until the end of my/our contract. I/We understand that interest will continue to accrue on the unpaid account balance. I/We understand that this does not include any additional insurance premium and that any insurance coverage provided in my/our contract will expire on the expiration dates shown on the insurance policies. By signing this document, I/we acknowledge the terms and conditions of this agreement. NOTE: All parties signed on the contract are required to sign this agreement. NOTE: This agreement is not valid until accepted and signed by a Regional Acceptance Manager. NOTICE TO CONSUMER:

1. DO NOT SIGN THIS IF IT CONTAINS ANY BLANK SPACES. 2. YOU ARE ENTITLED TO AN EXACT COPY OF ANY AGREEMENT YOU SIGN. 3. YOU HAVE THE RIGHT AT ANY TIME TO PAY IN ADVANCE THE UNPAID BALANCE DUE UNDER THIS AGREEMENT AND YOU MAY BE ENTITLED TO A PARTIAL REFUND OF THE FINANCE CHARGE. Borrower [Print]: Co-Borrower [Print]: Borrower Signature: Co-Borrower Signature: Date: Date:

BORROWER, please provide current information: CO-BORROWER, please provide current information: Home Address Home Address

Home Phone Home Phone

Cell Phone Cell Phone

Email Address Email Address

Employer Name and Address Employer Name and Address Work Phone Work Hours Work Phone Work Hours

Reference's Name Reference's Name

Reference's Phone Reference's Phone

Reference's Relationship Reference's Relationship

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