Promissory Note And Statement Of Disclosure



FOR VALUE RECEIVED, the undersigned promises to pay to the order

of_______________________________HOLDER the sum of $_____________ in consecutive, monthly payments of $___________ commencing one month from date hereof and thereafter on the same day
of each and every subsequent month until fully paid. Any unpaid balance may be prepaid at any time without penalty. In the event the undersigned defaults in any payment beyond _________ days from the agreed date of payment, the entire remaining balance will be due at the option of any holder of this note.


1. Principal Amount of Loan: $____________

2. Charges and fees: $____________




3. Total fees charged: $____________


4. Net amount to be advanced: $___________


_______________________ _________________________




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