For full value received the undersigned promises to pay to the order of _________ $_____ on _________, with interest at the rate of _________ percent per year payable _________, the principal and interest to be due and payable at the office of the payee or the holder of this note.

The principal shall become due on failure to pay the interest or [any installment of] principal as stipulated in the note within _________ days after due [maturity], and all overdue payments shall draw interest from the date of maturity at the rate of _________ percent per year.

Any attorney-at-law may appear in any court of record in the state of _________ or in the United States, after the above obligation becomes due, and waive the issuing and service of process, and confess a judgment against the undersigned, jointly or severally, in favor of the holder of this note, for the amount then appearing due, together with costs of action, and, immediately after that, release all errors and waive all right of appeal.

This note is secured by _________ to _________ upon _________.