Date: ______________________

For value received, ____________________, of ___________________________,

in this note referred to as Makers, jointly and severally, promise to pay to the order of ____________________, of _____________________________________, in the amount of ____________________ in ________ consecutive monthly payments of ________, beginning one month from the date of this note and thereafter continuing on the same day of each subsequent month until paid in full. Any unpaid balance may be paid, at any time, without penalty and any unearned finance charge will be refunded based on the Rule of 78s. In the event that Makers default on any payment, a charge of _____________________ may be assessed.

1. Proceeds: _________________

2. _________________________:

3. Amount financed (1 + 2): __________________

4. FINANCE CHARGE: ____________________

5. Total of payments: _____________________

ANNUAL PERCENTAGE RATE ____________ percent.

____________________________ Dated: __________________

(Signatures of Makers)