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FEDERAL RESERVE BANK OF DALLAS Dallas, Texas, December 19, 1941 NOTICE REGARDING THE “STATEMENT OF BORROWER” PRESCRIBED FOR USE IN CONNECTION WITH REGULATION W To All Banking Institutions, and Others Concerned, in the Eleventh Federal Reserve District: Regulation W, relating to consumer credit, which was issued by the Board of Gov ernors of the Federal Reserve System pursuant to Executive Order No. 8843 of the Pres ident of the United States, provides that, on and after January 1, 1942, no Registrant shall make any extension of instalment loan credit (with certain exceptions) unless, at or before the execution of the loan contract, he obtains and accepts in good faith a signed Statement of the Borrower as to the purposes of the loan in the form prescribed by the Board. A specimen copy of the form which the Board has prescribed for use in this connection is enclosed. The forms will not be supplied by the Board or by this Bank but should be printed or otherwise reproduced by the Registrant or obtained by him from stationery or supply houses. Your attention is called to the fact that the form should be reproduced only in accordance with the instructions at the top of the specimen form. Your attention is also called to the fact that Registrants are instructed to keep all such statements on file. Any inquiry relating to this form should be addressed to the Federal Reserve Bank of Dallas or to one of its branches at Houston, San Antonio and El Paso. Although the “ Statement of Borrower” is prescribed for use only in connection with the extension of instalment loan credit, this circular and form are being sent to dealers and other registrants for their information. Yours very truly, R. R. GILBERT President This publication was digitized and made available by the Federal Reserve Bank of Dallas' Historical Library (FedHistory@dal.frb.org) SPECIMEN FORM Form F. R. 564. FOR IN FORM ATI 9N OF REGISTRANT OR PRINTER ON LY— N O T T O BE PRINTED AS PART OF FORM: In reproducing this form, the Registrant or printer shall follow exactly the wording and arrangement o f the front and back of the form, hut may vary the spacing as desired. Additions to the form, such as an acknowledgment by the borrower that he has received a copy, are permitted provided they do not call for the obtaining o f any additional information from the borrower. Since the form may be changed from time to time, it is suggested that Registrants do not stock large supplies o f the form. STATEM EN T OF BORROWER Prescribed by the Board of Governors of the Federal Reserve System under its Regulation W , issued pursuant to Executive Order N o . 8843 of the President of the United States. TO BE FILLED IN BY REGISTRANT (Name of Registrant) --------------------(D ate of Loan) $----------------------(Amount of Loan) (Answer “ Yes” or “ No” ) 1. Is any of the money from this loan to be used to buy a Listed Article? (See statement on back of this sheet) 2. Is any part of this loan to be secured by any Listed Article which you have bought within the last 45 days or which you intend to buy? 3. Is any of the money from this loan to be used to pay all or part of any (A nsw er) (A nsw er) instalment debt? (A nsw er) 4. Is any of the money from this loan to be used as a down payment on the purchase of a Listed Article? (A nsw er) In determining whether any article involved in this loan is a Listed Article, I have been guided by information furnished by the lender. I certify that, to the best of my knowledge, the information given by me on this sheet is true and complete. (Borrower’ s Signature) (D a te) 5. IF EITHER Q UESTION 1 OR 2 HAS BEEN ANSWERED "YES”, the following information must be obtained from' borrower: Listed Article Bought or To Be Bought or Used as Security ------------------------------------------------ Purchase Price $____________ H ave you borrowed any money elsewhere, or do you intend specified above? ___________________________ Date Purchased W before loan) _____________ to borrow any, I f "Y e s ” , how much? to be Trade-in Allowance Amount To Be Borrowed $------------------- $-------------------- used in buying any of the Listed Articles $-------------------------------- (Answ er “ Yes” or “ No” ) 6. IF QUESTION 3 HAS BEEN ANSWERED "YES”, the following information must be obtained from borrower: Name of Person Holding Debt N O TICE T O LENDER.— The Total Unpaid Balance Instalment Terms Amount To Be Paid Off lender, acting in good faith, may rely upon the above statements of the borrower. H ow ever, this form does not provide all of the information that it may be necessary for the lender to have if he intends to avail himself of certain provisions of Regulation W . In any case as to which the lender must obtain additional infor mation in order to be protected in making the particular loan under consideration, the facts themselves will govern. This, however, does not affect the right of the lender to rely upon statements of fact obtained from the borrower pur suant to applicable provisions of the Regulation. THE REGISTRANT RECEIVING THIS STATEMENT MUST KEEP IT ON FILE LISTED ARTICLES The instalment purchase of classes of consumers’ durable goods using materials, labor, and equipment needed for national defense is regulated under the President’s Executive Order N o . 8843. Regulation W covers the extension of credit to buy these articles, whether bought directly on instalment payments or with money borrowed on an instalment basis. lowing are the classes of "Listed Articles” based upon the Supplement of Regulation W articles may be added to or taken from the list at any time. I N D E T E R M I N I N G W H E T H E R A N A R T IC L E I N V O L V E D I N A L O A N IS A "L I S T E D A R T IC L E ” A B O R R O W E R M A Y F U R N IS H E D B Y T H E LE N D E R , A N D CH AN G ES IN The fol in effect December 1, 1941, but BE G U I D E D B Y IN F O R M A T IO N R E G IS T R A N T S M U S T KEEP T H E M S E L V E S IN F O R M E D A S T O T H E S E "L I S T E D A R T IC L E S ” . PASSENGER AUTOMOBILES AIRCRAFT MOTOR BOATS A N D BOAT MOTORS MOTORCYCLES A N D MOTOR BICYCLES REFRIGERATORS A N D ICEBOXES W ASH IN G OR IRONING MACHINES VA CU U M CLEANERS COOKING STOVES HEATING STOVES A N D HEATERS ELECTRIC DISHWASHERS AIR CONDITIONING EQUIPMENT SEWING MACHINES RADIOS A N D PHONOGRAPHS M ETAL MUSICAL INSTRUMENTS FURNACES, OIL OR GAS BURNERS, A N D STOKERS W ATER HEATERS A N D PUMPS PLUMBING A N D SANITARY FIXTURES A T T IC VENTILATING FANS NEW HOUSEHOLD FURNITURE, BED SPRINGS A N D MATTRESSES PIANOS AN D ELECTRIC ORGANS MATERIALS A N D SERVICES USED IN CONNECTION W IT H REPAIRS, ALTERATIONS, OR IMPROVEMENTS OF BUILDINGS WARNING Regulation W provides that no borrower shall willfully make any material misstatement or omission in his Statement. The law under which the President’s Executive Order was issued reads in part: "W hoever willfully violates any of the provisions of this subdivision or of any license, order, rule or regulation issued thereunder, shall, upon conviction, be fined not more than $10,000, or, if a natural person, may be imprisoned for not more than ten years, or both; and any officer, director, or agent of any corporation who knowingly participates in such violation may be punished by a like fine, imprisonment, or both.”
@FedFRASER