SAMPLE FORM EXHIBIT A LETTER OF CREDIT NUMBER SIGHT

SIGHT DRAFT – SAMPLE FORM

EXHIBIT A

YOU, [NAME AND CITY OF THE FINANCIAL INSTITUTION], are directed to pay to the

order of the Commonwealth of Pennsylvania, Office of Attorney General, Bureau of

Consumer Protection

U.S. DOLLAR AMOUNT IN WORDS U.S. DOLLAR AMOUNT IN NUMBERS

Pursuant to your irrevocable letter of credit number LETTER OF CREDIT NUMBER

dated DATE OF LETTER OF CREDT regarding NAME OF HEALTH CLUB ADDRESS

(1) We, the Office of Attorney General, hereby certify that the amount of the

accompanying sight draft represents claim(s) in the form of final court judgment(s) filed

with us by buyers of Health Club contracts against NAME OF APPLICANT HEALTH

CLUB pursuant to §12 of the Health Club Act, Act of December 21, 1989, P.L. 672, 73

P.S. 2172.

(2) We, the Office of Attorney General, certify that [NAME OF FINANCIAL

INSTITUTION] has given us notice of at least ninety (90) days prior to the current

expiration date of letter of credit LETTER OF CREDIT NUMBER that NAME OF

FINANCIAL INSTITUTION elects not to extend said letter of credit for an additional

period of one (1) year; and that NAME OF APPLICANT HEALTH CLUB ADDRESS OF

letter of credit with other financial security acceptable to the Office of Attorney General

within thirty (30) days after the date of such notice.

This sight draft is drawn under NAME AND CITY OF FINANCIAL INSTITUTION Credit

Number LETTER OF CREDIT NUMBER dated ISSUE DATE and is accompanied by

the original letter for proper endorsement.

This dollar amount draw is a _____FULL_____PARTIAL draw on the total letter of credit

amount of TOTAL AMOUNT OF LETTER OF CREDIT.