Promissory Note and Disclosure Statement

Promissory Note and Disclosure Statement : [Federal Truth in Lending Act]

This letter should be typed in the official letter-head of the company.

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 based on the Rule of 78's. In the event the undersigned defaults in any payment beyond _ days from the due date, the entire balance may be due at the option of the holder.

1. Proceeds $

2. Other charges [itemize] $

3. Amount financed [1+2] $

4. Total of payments $

5. Annual Percentage Rate XX%

Promissory Note and Disclosure Statement