Agreement made on the (date), between (Name of Debtor) of (street address, city, state, zip
code), referred to herein as Debtor, and (Name of Lender), of (street address, city, state, zip
code), referred to herein as Lender.
Whereas, the Lender loaned to Borrower the sum of $ _______ on the (date); and
Whereas, Lender and Borrower agree that the Loan is a debt owed by the Borrower and will be
paid to the Lender;
Now, therefore, for and in consideration of the said Loan, the mutual covenants contained in
this Agreement, and other good and valuable consideration, the parties agree as follows:
1. Interest shall accumulate on the unpaid balance of the loan at a rate of _____% APR
and compounded monthly. All interest that accumulates will be added to the balance of the
2. The Borrower will make payments to the Lender on the _____ day of each month and
individual payments may not be anything less than $___________
3. If a payment is past due, a penalty of $__________will be added to the unpaid balance
of the loan.
4. If a check written by Borrower “bounces” a charge of $_________shall be added to the
unpaid balance of the loan, and all futur