1. Identification of Note. This Agreement refers to the loan evidenced by a promissory note of [date] (Note), executed by [name] (Maker), and presently held by [name], with offices at [address] (Holder), upon which the present principal balance is ---------- dollars ($----------) and interest at the rate of ---------- percent (----------%) per annum has been paid to [date].
2. Revision. The following revisions are made in the terms of the note: [list of revisions].
3. Maker's Promise to Pay. In consideration of Holder's acceptance of the revisions, and Holder's forbearance to enforce payment except in accordance with the revisions, Maker acknowledges and admits the indebtedness evidenced by the Note and unconditionally promises to pay the indebtedness with interest at the time and in the manner provided in the Note, as revised by this Agreement.
4. Security for Indebtedness. Any security held by Holder for the Note may be enforced by Holder concurrently or independently in such order as Holder may determine.
5. No Novation. This Agreement is a revision only, and not a novation. Except as otherwise provided, all of the terms and conditions of the Note shall remain in full force and effect.
6. Place and Time of Execution. Executed at [address] on [date].