Promissory Note & Disclosure Statement

Date:

FOR VALUE RECEIVED, the undersigned jointly and severally promise to pay to the order of, the sum of ($-------) Dollars in consecutive, monthly payments of $------ each, beginning one month from date hereof and thereafter on the same date of each subsequent month until paid in full. Any unpaid balance may be paid at any time without penalty and any unearned finance charges will be refunded. In the event that undersigned defaults in any payment beyond (--) days from the due date, the entire balance may be due at the option of any holder.

1. Proceeds $__________________________

2. Other charges (itemize) $__________________________

3. Amount financed $__________________________

4. Total of payments $__________________________

5. Annual Percentage Rate _______%

___________________________

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