Page 1. This frame shows an image of the "Federal Consumer Leasing Act Disclosures" form for segregated disclosures. The blanks are filled in with typical lease information. Circled numbers link certain terms used in the form to explanations. A narrative description of the page follows. The sample lease information entered in the blanks is included. Some terms are linked to explanations.

Federal Consumer Leasing Act Disclosures

Date 00/00/00

Lessor(s) Dealer or Leasing Company

1 Lessee(s) J. Smith

2 Amount Due at Lease Signing or Delivery
(Itemized below)*
$ 4,241.94

3 Monthly Payments
Your first monthly payment of $256.94 is due on 00/00/00, followed by 47 payments of $256.94 due on the 1st of each month. The total of your monthly payments is $12,333.12.

4 Other Charges (not part of your monthly payment)
Disposition fee (if you do not purchase the vehicle) $400.00
(blank line item) –0–
Total $400.00

5 Total of Payments
(The amount you will have paid by the end of the lease) $16,368.12

6 *Itemization of Amount Due at Lease Signing or Delivery

Amount Due at Lease Signing or Delivery:
Capitalized cost reduction $3,500.00
First monthly payment 256.94
Refundable security deposit 350.00
Title fees 75.00
Registration fees 60.00
(blank line item) –0–
6a Total $4,241.94

How the Amount Due at Lease Signing or Delivery will be paid:
Net trade-in allowance $2,500.00
Rebates and noncash credits –0–
Amount to be paid in cash 1,741.94
(blank line item)
6b Total $4,241.94

7 Your monthly payment is determined as shown below:

8 Gross capitalized cost. The agreed upon value of the vehicle ($21,500.00) and any items you pay over the lease term (such as service contracts, insurance, and any outstanding prior credit or lease balance) $22,300.00
If you want an itemization of this amount, please check this box.
9 Capitalized cost reduction. The amount of any net trade-in allowance, rebate, noncash credit, or cash you pay that reduces the gross capitalized cost – 3,500.00
Adjusted capitalized cost. The amount used in calculating your base monthly payment = 18,800.00
Residual value. The value of the vehicle at the end of the lease used in calculating your base monthly payment – 12,350.00
Depreciation and any amortized amounts. The amount charged for the vehicle's decline in value through normal use and for other items paid over the lease term = 6,450.00
10 Rent charge. The amount charged in addition to the depreciation and any amortized amounts + 5,295.00
Total of base monthly payments. The depreciation and any amortized amounts plus the rent charge = 11,745.00
11 Lease payments. The number of payments in your lease � 48
Base monthly payment = 244.69
12 Monthly sales/use tax + 12.25
(blank line item) + –0–
13 Total monthly payment = $256.94

14 Early Termination. You may have to pay a substantial charge if you end this lease early. The charge may be up to several thousand dollars. The actual charge will depend on when the lease is terminated. The earlier you end the lease, the greater this charge is likely to be.

Excessive 15 Wear and 16 Use. You may be charged for excessive wear based on our standards for normal use and for mileage in excess of 15,000 miles per year at the rate of .15 per mile.

17 Purchase Option at End of Lease Term. You have an option to purchase the vehicle at the end of the lease term for $12,350.00 and a purchase option fee of $150.00.

Other Important Terms. See your lease documents for additional information on early termination, purchase options and maintenance responsibilities, warranties, late and default charges, insurance, and any security interest, if applicable.