DISCLOSURE AGREEMENT

By signing this application, I ask that a membership account in the Butte Country Club be opened and remain open pending my written request to the Club for cancelation. I agree to be bound by the conditions governing my account set forth on this application and to be liable for all charges to my account, including charges incurred by those immediate family members listed in this application now or in the future. I understand that should I default on payment of my account and collection agency services are required, all costs of collections up to 50% of the balance, including attorney/court costs will be added to the balance of my account. I understand that I must provide all the information requested on this application and I certify that such information is accurate. I authorize the Butte Country Club to verify the information on this application and to receive and exchange information about me, including requested reports from consumer reporting agencies. If I ask whether or not a consumer report was requested, you will tell me if you received a report, and you give me the name and address of the agency that furnished it. I authorize BCC to contact these sources at any time, and understand that all information received will be used for administrative and internal marketing purposes only and be kept in the strictest of confidence between myself and the club. I acknowledge that any benefit, service, or condition of this account may be modified or terminated by written notice. If any legal action is pursued to enforce the terms of this agreement the proper venue shall be Silver Bow County, Montana. Additional information may be requested by the BCC for further processing when you apply on this form. By clicking the submit button below, you certify that you have read, met and agreed to all terms, conditions and disclosures on this application.