Bank note.

Account Number: _________


[date] _________(Date of execution and delivery)


Lender: _________ bank _________(no. & street, city, county, state)

Borrower-Debtor(s): _________(type full names) _________(no., street or RFD, city, county, state)

Borrower(s) represent here that the loan evidenced by this means is being obtained for the following primary purpose: [ ] Personal family or household [ ] Farming operations [ ] Business

For value received, that is, money loaned, the undersigned borrower-debtor(s) named above (hereafter collectively termed "debtor"), jointly and severally (if more than one debtor), promise(s) to pay to the order of _________ bank (hereafter termed "lender") at its office in the city above, the sum of $_____ which total sum includes interest for the term of this loan at the agreed contract rate of _________ percent per year, and with interest at the contract rate after maturity, until paid. [ ] If checked here, repayment terms are stated on attached schedule "B", incorporated here by reference. Otherwise payable _________ after date, or payable in consecutive monthly installments, commencing on [date], in _________ equal payments of $_____ plus an irregular payment of $_____ due on [date] (delete payment terms inapplicable), together with a delinquency charge of _________ percent of each installment in default for _________ or more days. Further, in case action is instituted, upon debtor's default (as hereafter defined), to enforce collection of any unpaid balance under this note, debtor agrees to pay all collection and legal expenses and the reasonable attorney's fees incurred by lender. Debtor stipulates and agrees that _________ percent of the sum of the unpaid principal and all interest due on that at the time action is instituted by lender shall be deemed reasonable attorney's fees.

Each of the undersigned, whether maker-debtors, sureties, indorsers, or guarantors and all others who may become liable for all or any part of the obligations evidenced and secured by this means, jointly and severally waive presentment, demand, protest, notice of protest and/or dishonor and also notice of acceleration of maturity on default or otherwise. Further, they agree that lender may, from time to time, extend or renew this note for any period (whether or not longer than the original period of the note) and grant any releases, compromises or indulgences with respect to the note or any extension or renewal of or any security for, or to any party liable under this note, all without notice to or consent of any of the undersigned and without affecting the liability of the undersigned. The undersigned, further, waive notice of acceptance of their guaranty and expressly agree to pay all amounts under this note, upon demand, without requiring any action or proceeding against the principal debtor-maker(s).

This negotiable promissory note is subject to the additional provisions, terms, undertakings and rights set forth on the reverse side, and they are incorporated here by reference.

Additional Disclosures to Borrowers Required by Federal Law

Balloon payment, if any $_____. The payment may not be refinanced, if not paid when due. If the loan contract is prepaid in full by cash, a new loan, refinancing, or otherwise before the final installment date, borrowers shall receive a rebate of precomputed interest, computed under _________ percent of the rule of 78's. The only security for the loan is lender's right of set-off, as provided by law.

Insurance Disclosures:

Credit life and/or disability insurance are not required to obtain this loan, purchase of such through lender being voluntary on borrower's part. No such credit insurance is provided unless the borrower to be insured under such credit insurance policy signs the appropriate statement below:

(a). The premium (cost) for credit life insurance will be $_____, for the term of the credit.

(b). The premium (cost) for credit life and disability insurance will be $_____, for the term of the credit.

I desire credit life and disability insurance.

(Date) _________

_________(Signature of customer to be insured)


I desire life insurance only.

(Date) _________

_________(Signature of customer to be insured)


Basic Terms of Loan Agreement:

1. Loan Proceeds $
2. Other Charges: (Total) $
a. Premium, Credit Life $  
b. Premium, Disability Ins. $  
c. Other $  
3. Less: Prepaid Finance Charge $  
Required Deposit Balance $  
4. Total Prepaid Finance Charge and Required Deposit Balance $
5. Amount Financed $
(Nos. 1 + 2 minus No. 4)    
6. Finance Charge $
7. Total of Payments $
8. Annual Percentage Rate _________ percent


Acknowledgment of Receipt of Disclosures

The undersigned borrowers acknowledge receipt of the disclosures contained in this agreement and in the negotiable promissory note. They, further, acknowledge that at the time they received a copy of this statement and of the negotiable promissory note, such forms were complete and filled-in and that all blanks in such were filled in prior to their executing them.

In witness, the parties have executed this agreement [date].

Witness: _________

Debtor _________(Seal)

Witness: _________

Debtor _________(Seal)

Witness: _________

Debtor _________(Seal)

[Reverse side]

Additional Provisions

Debtor further warrants, covenants, and agrees, as follows:

If any installment due and payable under this note is in default for _________ or more days, or if the payment and maturity of the entire unpaid outstanding balance under this note shall be accelerated and matured by reason of the occurrence of any of the "events of default," as hereafter defined, lender is expressly authorized to exercise its right of set-off or bank lien as to any monies deposited in demand, checking, time, savings or other accounts of any nature maintained in and with it by any of the undersigned, without advance notice. The right of set-off shall also be exercised and applicable where lender is indebted to any signer of this note by reason of any certificate of deposit, bond, note, or otherwise. Lender, as further security for the payment of this note, is granted a lien and security interest in and to any funds now or at any future time loaned to or deposited with it by any of the signers of this note.

Events of Default

Debtor shall be in default under this agreement, upon the happening of any of the following events, circumstances or conditions, namely:

(1) Default in the payment or performance of any of the installments or other obligations or of any covenant, warranty or liability contained or referred to in this note; or

(2) Any warranty, representation or statement made or furnished to lender by or on behalf of debtor, in connection with this agreement or to induce lender to make a loan to debtor proving to have been false in any material respect when made or furnished; or

(3) Death, dissolution, termination of existence, insolvency, business failure, appointment of a receiver of any part of the property of, assignment for the benefit of creditors by, or the commencement of any proceeding under the bankruptcy or insolvency laws by or against debtor or any indorser, guarantor or surety for the debtor; or

(4) Failure of a corporate debtor or indorser, guarantor or surety for the debtor to maintain its corporate existence in good standing; or

(5) Upon the entry of any monetary judgment or the assessment and/or filing of any tax lien against debtor, or upon the issuance of any writ of garnishment or attachment against any property of, debts due or rights of debtor, to specifically include commencement of any action or proceeding to seize monies of debtor on deposit in any bank account with lender; and/or

(6) If lender should otherwise deem itself, or the debt unsafe or insecure, or should the lender, in good faith, believe that the prospect of payment or other performance is impaired.

Upon the occurrence of any of the events, circumstances or conditions of default stated above all of the obligations evidenced in this agreement and secured by this means shall immediately be due and payable, without notice.

(See other side for signatures and seals.)

Guaranty of Third Persons

Undersigned, jointly and severally, guarantee the payment, when due, to any holder of this note, of all amounts from time to time owing under it, and the payment, upon demand, of the entire amount owing on the agreement stated above, in the event of default in payment by debtor(s) named in it. Undersigned waive(s) notice of acceptance of this guaranty, acknowledge themselves as fully bound by all provisions of the agreement, and expressly agree to pay all amounts owing under this agreement, upon demand, without requiring any action or proceeding against debtor(s).

_________(Guarantor) (Seal)


_________(Guarantor) (Seal)





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