DIY Legal Forms

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Disclosure Statement & Note

(Type A)

Federal Truth-in-Lending Act


Amount: [$------].

FOR VALUE RECEIVED, the borrower [Name], residing at [Address], shall pay to the order of [Name], the total amount of [$------] in consecutive payments payable on the [--th] day of the [Month], beginning on [Date], until the loan is paid in full.

Failure to make a payment when due shall be a default of the loan. Should a default exist for more than [--] days, the holder of this note may cause the entire loan to be due immediately.

1. Amount of Loan:

2. Expenses:

3. Total Financed:

4. Interest Charges:

5. Total of Payments:

6. Annual Financed Percentage Rate:


[Name], Borrower

This Section for Notary:


State of _________

County of ________ [COUNTY]

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.

Signature ________

My commission expires: _____