How to prepare legal forms (click here)

Receipt For Collateral

This receipt is made in connection the Promissory Note dated ______, 20 _, and the Security Agreement dated ______, 20 __, between the Borrower _________________, of _________________, City of _______, State of __, and the Noteholder/Secured Party ____________, of ______________, City of ________, State of ____.

The Noteholder/Secured Party acknowledges delivery of the following described personal property as collateral under the Security Agreement:

This collateral is subject to the lien and all of the conditions of the Security Agreement. In the event of the Borrower's default on any of the terms of the Note or Security Agreement, this property may be disposed of by the Noteholder/Secured Party to satisfy any of the Borrower's obligations as allowed by law.

The Borrower will continue to pay all costs and expenses relating to this property, including any maintenance, storage fees, insurance, or taxes.

This receipt does not acknowledge the condition or the value of the property retained as collateral.

Dated:

_____________________________

(Signature of Borrower)

_____________________________

(Signature of Secured

Party/Noteholder)

By: _________________________

(Name of Borrower)

By: _________________________

(Name of Secured

Party/Noteholder)