SECTION ONE

TERMS OF NOTE

For value received, __________________ (maker), of _______________________ (address), __________________ (city), ____________ (county), _______________ (state), in this note referred to as maker, promises to pay to the order of ___________ (financial institution), of ______________________ (address), _________________ (city), ____________ (county), _________________ (state), in this note referred to as institution, at ______________________ (address), __________________ (city), ____________ (county), ________________ (state), the principal sum of __________ ($__________) with interest thereon at __________ percent (__________%) per year in installments as follows: ____________ (amount) ($__________) in __________ (number) ______________ (monthly) installments of __________________ (amount) ($__________) each, beginning on ____________ (date), continuing on the same day of each ______________ (month) until the final installment.

The final installment on ____________ (date) shall be a BALLOON PAYMENT of __________ (amount) ($__________). The balloon payment may not be refinanced, if not paid when due. The finance charge applies from ____________ (date).

SECTION TWO

REQUIRED DISCLOSURES

1. Amount of loan $____________

2. Other charges (itemize)

a. Insurance $ _____________

b. Official fees ____________

c. Taxes ________________

d. Total cost related to security ______________

e. Total costs related to documents ____________

f. ____________ (itemize other charges)

g. Total of other charges $_____________

3. Amount financed (1 + 2) $____________

4. ____________ (Prepaid finance charge or Required deposit balance or Total prepaid finance charge and required deposit balance) $____________

FINANCE CHARGE

a. Interest $___________

b. Amounts due under discount ____________

c. Loan fees _______________

d. Fees of finder ____________

e. Credit report costs ____________

f. Charges for insurance for protection against default of maker ____________

g. Charges for credit life, health, and accident insurance _________________

h. ____________ (other items)

5. TOTAL FINANCE CHARGE $____________

6. Total of payments $____________

7. ANNUAL PERCENTAGE RATE __________%

SECTION THREE

INSURANCE

PROPERTY INSURANCE, if written in connection with this note, may be obtained by maker through any person of __________ (his or her) choice. If maker desires property insurance to be obtained through institution, the cost will be ______________ (amount) ($__________) for the term of the note.

CREDIT LIFE AND DISABILITY INSURANCE is not required to obtain this loan, no charges made for credit and no credit insurance is provided unless maker signs the appropriate statement below.

(a) The costs of credit life insurance will be __________ Dollars ($__________) for the term of the credit.

(b) The cost for credit life and disability insurance will be __________ Dollars ($__________) for the term of the credit.

Maker desires credit life and disability insurance:

Dated: ____________

-

____________________________

(Signature of Maker)

Maker desires credit life insurance only:

Dated: ____________

______________________________

(Signature of Maker)

Maker does not want credit life or disability insurance:

Dated: ____________

_________________________________

(Signature of Maker)

SECTION FOUR

PREPAYMENT OF UNPAID BALANCE

Maker may prepay at any time any unpaid balance of this note. On prepayment in full, maker will be entitled to a refund of the unearned financed charge computed on the Rule of 78s.

SECTION FIVE

DELINQUENCY CHARGES

If any installment or portion thereof continues unpaid for more than __________ days following the date such payment is due, maker shall pay to lender __________ percent (__________%) of each delinquent installment or _________ Dollars ($__________), whichever is less.

SECTION SIX

COLLATERAL

Maker grants to institution a security interest in, subject to the terms and conditions of this note, the following described property:

Market value on

Description ____________ (date)

__________ $_________

__________ __________

__________ __________

Total $___________

Maker shall also grant to institution a security interest in all other property of maker that now or hereafter comes into the possession or under the control of institution for any purpose, including dividends, distributions, or other rights in connection with any such property of maker.

SECTION SEVEN

PROTECTION OF COLLATERAL

The collateral will be kept at the address of maker. Maker will notify institution promptly of any change in the location of the collateral, and maker will not remove the collateral from ____________ (state) without the prior written consent of institution.

Maker will keep the collateral in good order and repair and will not use it in violation of any statute or ordinance. Institution may examine and inspect the collateral at all reasonable times.

SECTION EIGHT

PERFECTION OF COLLATERAL

No financing statement covering the collateral or any part thereof or any proceeds thereof is presently on file in any public office. At the request of institution, maker will join in executing all necessary financing statements in form satisfactory to institution and will pay all costs of filing, financing, continuation, or termination statements with regard to the security interest of institution created by this note.

SECTION NINE

PROTECTION OF SECURITY INTEREST

Maker will not, without the written consent of institution, sell, contract to sell, lease, encumber, or dispose of the collateral, or any interest in the collateral, until this note and all obligations secured hereby have been fully performed.

Maker will pay when due all taxes and assessments imposed on the collateral.

SECTION TEN

COSTS OF COLLECTION

Maker shall pay on demand of institution all costs of collection, including legal expenses and attorney fees, incurred by institution in enforcing this note on default.

SECTION ELEVEN

TIME OF ESSENCE

Time is of the essence of this note.

SECTION TWELVE

EFFECT OF WAIVER OF RIGHTS

Acceptance of a partial or a delinquent payment by institution or the failure of institution to exercise any right or remedy under this note shall not be a waiver of any of the obligations of maker or the rights of institution or constitute a waiver of any other similar default occurring at a later date.

SECTION THIRTEEN

RIGHTS AND REMEDIES OF INSTITUTION ON DEFAULT

On the nonpayment of any installment when due under the terms of this note or on the occurrence of any other event of default, institution at its option may declare, at that time or at any time thereafter, all the remaining installments immediately due and payable and may proceed to enforce payment of this note by exercising all rights and remedies provided by the __________ (Uniform Commercial Code) of __________ (state). Institution may also require maker to assemble the collateral and make it available to institution at any place to be designated by institution that is reasonably convenient to both parties. Institution may sell, lease, or otherwise dispose of any or all of the collateral in its then condition or following any commercially reasonable preparation or processing.

SECTION FOURTEEN

NOTICE OF SALE

Unless the collateral is perishable or threatens to decline speedily in value or is of a type customarily sold on a recognized market, institution will give maker reasonable notice of the time and place of any public sale thereof or of a time at which any private sale or other intended disposition is to be made. The requirements of reasonable notice shall be met if such notice is mailed, by __________ (certified or registered) mail, with postage prepaid and return receipt requested, to the address of maker as shown above at least __________ days before the time of the sale or disposition. Maker agrees that these provisions for notice are reasonable.

SECTION FIFTEEN

DISPOSITION OF PROCEEDS FROM SALE OF COLLATERAL

After deducting all costs and expenses of every kind incurred in the retaking, holding, advertising, and selling or otherwise disposing of the collateral, all of which costs and expenses maker hereby agrees to pay, institution may apply the net proceeds of the sale or other disposition of the collateral to the payment of this note and to one or more of any of the other obligations that maker owes to institution, in such order as institution may elect. In applying the net proceeds to the payment of this note and the other obligations that maker owes to institution, proper rebates for interest already paid or appropriate discounts for interest not yet earned shall be made. Only after full payment of this note and all such other obligations and any other payments institution may be required to make by law, need institution account to maker for the surplus. Maker shall remain liable to institution for the payment of any deficiency with interest at the rate of __________ percent (__________%) per year.

SECTION SIXTEEN

ASSIGNMENT BY INSTITUTION

Institution may assign this note and all rights and privileges will inure to its successors or assigns.

SECTION SEVENTEEN

DEFINITION OF INSTITUTION

The word institution shall include institution or any other indorsee of this note, who is in possession of it, or the bearer of this note, if this note is at the time payable to bearer.

SECTION EIGHTEEN

RECEIPT OF NOTE BY MAKER

Maker acknowledges the receipt of a copy of this note containing the disclosures of information applicable to this transaction.

NOTICE TO MAKER: Do not sign this instrument before you read it and do not sign this instrument if it contains any blank spaces. You are entitled to a copy of this instrument. You have the right to pay in advance the unpaid balance of this instrument and obtain a partial refund of the FINANCE CHARGE based on the Rule of 78s. Keep this instrument to protect your legal rights.

Dated: ____________

_____________________________

(Signature of Maker)