(state) ____________ (month & day), ______ (year)
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).
memorandum collateral is as follows: __________ (insert memorandum).
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.
terms and conditions are:
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
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.
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
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.
may treat the registered holder of the certificate as the absolute owner.
of Corporate Officer Date