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Back to Forms for 'Debtor and Creditor'.








__________ ($__________)

No. __________

__________ (city)

__________ (state)              ____________ (month & day), ______ (year)


We hereby certify that participant bank has advanced __________ ($_________) for a loan of __________ ($_________) made by us to __________ (name of borrower) dated ____________ (month & day), ______ (year) and maturing on ____________ (month & day), ______ (year).


The memorandum collateral is as follows: __________ (insert memorandum).


All payments or collections on the principal or interest from whatever source derived, including collateral and all sums realized from any endorser, guarantor or other person liable with respect to such loan or from the exercise by us of any lien or right of setoff with respect to any deposit balance or other property of the borrower or other person liable with respect to such loan are to be applied pro rata to our respective participation and your share thereof remitted to you, less a proportionate share of cost, if any, including attorney fees incurred in the enforcement thereof.


Other terms and conditions are:


We shall hold, administer and liquidate the loan and dispose of the collateral, if any, on your behalf, subject to your approval, and we will promptly advise you of any default of action to be taken in the administration and enforcement of the loan.  We shall be without responsibility under this instrument except for our own willful misconduct or gross neglect.


We shall remit to you, when received, interest at the rate of __________ percent (_____%) on your share of the loan, calculated on the basis of three hundred and sixty-five (365) days per year.


We reserve the right to purchase at our option your participation or any part thereof at any time for the unpaid amount of such participation plus accrued interest, but agree that we will not sell or transfer our participation in the loan.


This certificate is transferable on our books on due endorsement and surrender of it, and a new certificate, transferred in like manner, will thereupon be issued in the name of the transferee.


We may treat the registered holder of the certificate as the absolute owner.


___________________________                           ___________

Signature of Corporate Officer                                   Date


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