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(As Collateral Security to Secure Payment)
Know all men by these present that [Name] of [Address], for valuable consideration paid, hereby deposits and pledges with [Name], as collateral security to secure the payment of [$------] on [Date] with [--%] percent interest per annum, payable [Enumerate] as provided in note of even date, or any renewals thereof and to secure the payment of any other direct or indirect, primary or secondary liability, joint or several, or any renewals thereof, of the undersigned to said [Name], due or to become due, or that may hereafter be contracted and to secure any judgment on any of the foregoing, the following described property:
The holder hereof may collect any part of said security by any lawful means. In witness whereof we hereunto set our hands and seals on [Date].
This Section for Notary:
STATE OF -------)
) ss: [date]
COUNTY OF ------)
On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
[Name of Notary Public]
My commission expires: [date]