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This ~ote may be prepaid in full at any time and a{xo-rote refund of the FINAIVCE CHARG~ will be mede, twt tFis ~
FItvANCE CHARGE retained by the holder shall not be less than 53.00.
Credit life and Disability lnaurance is r~ot required to obtain this loen. No charge is made for tredit insursnce and no
credit ins~rance is provided unless signed for below.
The ur~dersigned desires Credit life Insurance for a cost of s________________________ for the term of the credit and warrants that
his age is Years. D.O.B. y--------------------
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_
Date
The undersigned desires Credit Life and Disabifity Insurance for a cost of 3__ for the term of the credit and
warrants that his age is _ years. D.O.B.
. .
Date
The maker gives the bank a securiry interest in any funds from time to lime on deposit with the bnnk and the bank may
at any time set off any such amount against the indebtedness evidenced by this note whether this note is due or not.
The unde?sig~ed acknowfedges receipt of a copy of this note, and agrees to a!I the terrr~s contained herein.
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