(For Delinquent Renters. Require renter to fill out this form at your office. This is legally binding must be paid as agreed or legal action can and should be taken.)

FOR VALUE RECEIVED, _____________________________________________________________________of

ADDRESS________________________________________CITY___________________STATE_____ ZIP______

Promise (s) to pay to the order of___________________________________________________________________

The principal sum of ________________________________________and/100 DOLLARS ( $ _______), in legal tender of the United States, with interest form the date hereof at the rate of ________% per year or any part thereof. Should this not be paid in full within thirty days from the date hereof or ant any time during a thirty day period, interest shall be charged at a daily rate of $______ per day.

Principal and interest shall be payable at the offices of:

________________________________________

________________________________________

________________________________________

________________________________________

Or at such other place as the holder hereof may designate in writing.

Should any installment not be paid when due, or should the Maker or Makers hereof fail to comply with any of the terms of this agreement, or if Holder deems itself insecure or if Maker defaults under these terms, the entire unpaid principal sum evidenced by this Note, with all agreed interest, shall, at the option of the Holder, and without notice to the undersigned, become due and may be collected forthwith, time being of the essence of this Agreement. It is further agreed that failure of the Holder to exercise this right of accelerating the maturity of the debt, or indulgence granted from time to time, shall in no event be considered as a waiver of such right of acceleration or estop the Holder form exercising such right.

Installments, or payment ( if single payment Note), not paid within 5 days of due date shall incur a late fee of 15% of the installment or payment, but not less than $ 10.00. The Holder shall be entitled to all costs of collection should this Note, or any part of the indebtedness evidenced hereby, be accelerated and not paid. Should this note be collected at law or by an attorney at law, and Attorney/Collection fee of 15% of the balance due, but not less than $ 100.00, plus any costs and administration fees, shall be added.

And each of the undersigned, whether principal, surety, guarantor, endorser, or other party, severally waives and renounces demand, protest, notice of demand, protest and non-payment.

IN WITNESS WHEREOF, the parties hereto have caused these presents to be signed in person this______day of __________20____

(SEAL)

PAYMENT SCHEDULE: