Promissory Note Form

STATE OF ARIZONA
MARICOPA COUNTY

I, (Item 1) (The Undersigned), being over eighteen (18) years of age, do hereby acknowledge my indebtedness to Theta Gamma Chapter of Delta Tau Delta Fraternity, a fraternal association, in the amount of $ (Item 2) Said indebtedness (to include any further debt in addition thereto incurred by me) shall be paid as follows:

Amount: $ (Item 2)
Length of Note: (Item 3)
Payment Schedule: (Item 4)
Payment Amount: (Item 5)

It is acknowledged that time is of the essence; it being expressly understood and agreed that if default is made in the payment of any of the aforesaid installments, or any part thereof, as and when the same shall become due and payable, then, and in such event, the unpaid balance of the aforesaid principal sum, at the option of the holder hereof, may become due and payable, anything herein above contained to the contrary notwithstanding. In the event of such default in the acceleration of the unpaid balance, said amount shall bear interest at the rate of ten percent (10%) per annum from the date of such default. If said indebtedness is collected by law or through an attorney at law, the undersigned agrees to pay all costs of collection, including fifteen percent (15%) as attorneys’ fees. The undersigned waives demand, protest, and notice of demand, protest and non‑payment. This contract is to be construed in all respects and enforced according to the laws of the State of Arizona. The undersigned may prepay at any time without penalty.

The undersigned hereby irrevocably makes, constitutes and appoints the President of said Chapter as his true and lawful attorney for purposes of service of process as to any proceeding brought under this Note. Said attorney‑in‑fact and agent for service of process shall upon such service deliver to the last known address of the undersigned by mail, any such process or notices; service upon said attorney‑in‑fact being acknowledged as service upon the undersigned.
NOTE: Should default occur, prior to filing suit, consult with your house corporation or their attorney.

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STATE OF ARIZONA MARICOPA COUNTY I, (Item 1) (The Undersigned), being over eighteen (18) years of age, do hereby acknowledge my indebtedness to Theta Gamma Chapter of Delta Tau Delta Fraternity, a fraternal association, in the amount of $ (Item 2) Said indebtedness (to include any further debt in addition thereto incurred by me) shall be paid as follows: Amount: $ (Item 2) Length of Note: (Item 3) Payment Schedule: (Item 4) Payment Amount: (Item 5) It is acknowledged that time is of the essence; it being expressly understood and agreed that if default is made in the payment of any of the aforesaid installments, or any part thereof, as and when the same shall become due and payable, then, and in such event, the unpaid balance of the aforesaid principal sum, at the option of the holder hereof, may become due and payable, anything herein above contained to the contrary notwithstanding. In the event of such default in the acceleration of the unpaid balance, said amount shall bear interest at the rate of ten percent (10%) per annum from the date of such default. If said indebtedness is collected by law or through an attorney at law, the undersigned agrees to pay all costs of collection, including fifteen percent (15%) as attorneys’ fees. The undersigned waives demand, protest, and notice of demand, protest and non‑payment. This contract is to be construed in all respects and enforced according to the laws of the State of Arizona. The undersigned may prepay at any time without penalty. The undersigned hereby irrevocably makes, constitutes and appoints the President of said Chapter as his true and lawful attorney for purposes of service of process as to any proceeding brought under this Note. Said attorney‑in‑fact and agent for service of process shall upon such service deliver to the last known address of the undersigned by mail, any such process or notices; service upon said attorney‑in‑fact being acknowledged as service upon the undersigned. NOTE: Should default occur, prior to filing suit, consult with your house corporation or their attorney.

Current Date (Date that you are submitting this request)

Submission Month *

Today's Date *

Today's Year *

(Item 1): Legal Name (The Undersigned) *

First

Last

(Item 2): Amount of U.S. Dollars ($) Owed to Chapter *

(Item 3): Length of Note (End Date)

(Item 3) - Month *

(Item 3) - Day *

(Item 3) - NOTE END YEAR *

(Item 4): Payment Schedule *

Weekly Bi-Weekly Monthly Other

If (Item 4) is "Other" detail here *

(Item 5): Each Payment Amount *

Your Current Email Address *

Current Cell phone Number *

Current Home Address *

Line 1

Line 2

City

State

Zip Code

Country

By Clicking "I agree" and also clicking the "Submit" button below you are agreeing to pay this promissory note and are electronically signing your name into the record. This electronic record is enforced by: Section 7 of UETA: LEGAL RECOGNITION OF ELECTRONIC RECORDS, ELECTRONIC SIGNATURES, AND ELECTRONIC CONTRACTS. (a) A record or signature may not be denied legal effect or enforceability solely because it is in electronic form. (b) A contract may not be denied legal effect or enforceability solely because an electronic record was used in its formation. (c) If a law requires a record to be in writing, an electronic record satisfies the law. (d) If a law requires a signature, an electronic signature satisfies the law. Note: This promissory note is not valid until your receive a confirmation email from the Finance Committee that acknowledges that we have read and accepted your Promissory Note. Only at that time will this promissory note go into effect. (It may take up to 72 hours for your request to be processed.) Do you agree to pay this promissory note and the terms and conditions outlined above? *

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