Fill and Sign the Security Sale Form

Promissory Note and Security Agreement with Regard to the Sale of an Automobile from One Individual to Another FOR VALUE RECEIVED , the undersigned       of (Name of Purchaser/Debtor)       , does hereby promise to pay to (Street Address, City, County, State, Zip Code)       , or order, the principal sum of $       , (Name of Seller/Creditor) together with interest thereon from date at the rate of       Percent (       %) per annum on the unpaid balance until paid. The said principal and interest shall be payable at       , or at such other place as the holder hereof may (Street Address, City, County, State, Zip Code) designate in writing, in       consecutive monthly installments of $       . The (Number) first of said installments shall be due and payable on       , and each subsequent (Date) monthly installment shall be due and payable on the first day of each succeeding month thereafter until the entire indebtedness evidenced by this Note is fully paid, except any remaining indebtedness, if not sooner paid, shall be due and payable on       . (Date) The undersigned may prepay the principal amount outstanding in whole or in part without penalty. The undersigned further promises to pay the holder of this Note a late charge of       Percent (       %) of any monthly installment not received by the Noteholder within       days after the installment is due. It is agreed that in the event default is made in the payment of this Note at maturity, or of any installment thereof, whether maturing by expiration of time, by default as herein provided, or as provided in the Security Agreement below, and the same is placed in the hands of an attorney for collection, then an additional amount of       Percent on the principal and interest of this Note shall be added to the same as a collection fee, and the failure to pay any installment when due shall mature the entire indebtedness at the option of the holder of this Note. The Maker waives presentation for payment, demand, protest, diligence in collecting, notice of dishonor, notice of extension of time, and notice of protest or nonpayment. This Note is to be secured by a security interest in the Automobile described below which was financed by the Payee of this Note. Said Automobile is described as follows:  Color:       ;  Make:       ;  VIN:       ;  Body Type:       ; and  Year Manufactured:       Promissory Note and Security Agreement Page 1 of 2 The undersigned       , hereinafter called Debtor, hereby (Name of Buyer/Debtor) grants       , hereinafter called Secured Party , a security (Name of Seller/Creditor) interest in the above described Automobile. This Agreement shall constitute a security agreement under Article 9 of the Uniform Commercial Code of       , (Name of State) (the UCC ) with respect to the Automobile covered by this Agreement. Debtor hereby appoints Secured Party as his attorney - in - fact to execute, endorse and file on his behalf the certificate of title of the Automobile should Debtor not properly endorse same within five (5) days of the execution of this Agreement. Secured Party shall have all of the rights conferred upon a secured party by the Uniform Commercial Code of       . Secured Party may exercise any or all of (Name of State) the remedies of a secured party available to him under the UCC with respect to said Automobile, and it is expressly agreed that if upon default Secured Party should elect to dispose of the Automobile in accordance with the provisions of the Code, ten (10) days' notice by Secured Party to Debtor shall be deemed to be reason able notice under any provisions of the Code requiring such notice. WITNESS MY SIGNATURE, as of the day and date first above named. (Signature of Purchaser/Debtor)       (Printed Name of Purchaser/Debtor) Promissory Note and Security Agreement Page 2 of 2