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(As Collateral Security to Secure Payment)



Know all men by these present that , of , for valuable consideration paid, hereby DEPOSITS and PLEDGES with , as collateral security to secure the payment of ____________________ ($ _______ ) on __________________ (Month & Day), _______ (Year) with __________ percent interest per annum, payable ______________________________ 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 ________, 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 this _______________________ (Month & Day), ________(Year).




_______________________________                    ____________________

Signature                                                                                           Date




Witnessed BY:  _________________________________________



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