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Promissory Note – Installment Form is a legal instrument signed by the debtor for the holder to promise to pay the loan amount as agreed mutually. The debtor further has choices to select the repayment mode in accordance with the convenience and facility of the holder.


State laws of the respective state govern the jurisdiction of the promissory note and furnishing the name of the state in the space provided is therefore a need. Furnishing the details of the borrowing transaction is required to validate the promissory note and for the legal standing of the same. Signing Promissory Note – Installment Form executes it.


Important Features

  • The holder of the signed and executed Promissory Note Installment Form has rights to recover the money and the debtor is liable for paying the expenses incurring for the same.
  • The instrument has provision to begin the repayment on the specified date and the subsequent installment on the second week thereafter.
  • Furnish details of the monetary transactions like the loan amount, repayment schedule, and the repayment mode on the respective fields to quantify the transaction and its obligation to both the parties.
  • The installment paid towards the repayment is filed in lieu of the interest first and then the principal loan amount.
  • Payroll deduction of the installment is possible provided the debtor prefers to select the mode for the same.

Insert the date, month, and year followed by the name of the city and state in the respective spaces in the Promissory Note Installment Form. Furnish the name of the debtor in the requested format. The first line in the main portion has space for the same. The second line requires the name of the individual and/or corporation that also acts as the lender and/or the holder. Furnishing names in these spaces define the roles of the debtor and the holder of the Promissory Note – Installment Form.

Type the amount of loan borrowed in words and figures on the next line followed by the number of installments in the words and figure. Continue by entering the installment amount in US dollar and the date of the repayment.

The succeeding portion of Promissory Note Installment Form requires furnishing the rate of interest in the words and figure. The rate of interest is charged on the remaining balance on an annual basis. Select the choice of repayment mode from either payroll deduction or payment in-person at the address of the holder or any place the holder designated. Mention the address of the holder in the space offered for the same.

Write the name of the state to define the jurisdiction of the Promissory Note – Installment Form followed by the seal and signature of the debtor to complete the execution of the instrument.

Promissory Note – Installment Form

Text Version of this Form

__________________ ,20___
________________ [City, State}

FOR VALUE RECEIVED, ____________________ (hereinafter “Debtor”) promises to pay to the order of ____________________ , a ___________________, corporation (hereinafter “Holder”) the sum of ____________________ ($ __________ ) in ____ (__) consecutive installments of $ __________ , the first such installment being due and payable on ___________, 20___ and each subsequent installment being due and payable two weeks thereafter.

Interest. This Note shall bear interest on the unpaid balance from the date hereof until the date of payment of each installment. Such interest shall be payable with such installments of principal at the rate of _________________ (______%) percent per annum.

Payments. At Holder’s option, payments of both principal and interest may be made either:

(a) by payroll deduction from each paycheck that Holder issues to Debtor until this Note is completely paid off, or

(b) at the office of Holder at ___________________, ___________________, ___________________ or at such other place as Holder shall designate to Debtor in writing, in lawful money of the United States of America in immediately available funds.

Each payment hereunder shall be applied first to interest on the outstanding balance and next to principal.

Default. If any of the following events of default shall occur for any reason whatsoever:

(a) if the Debtor defaults in the payment of any installment provided for herein for more than three (3) days after the same shall become due and payable; or

(b) if the Debtor makes an assignment for the benefit of creditors or admits in writing his inability to pay his debts generally as they become due; or

(c) if an order, judgment, or decree is entered adjudicating the Debtor bankrupt or insolvent; or

(d) if the Debtor petitions or applies to any tribunal for the appointment of a trustee or receiver of the Debtor; or of any substantial part of the assets of the Debtor, or commences any proceedings relating to the Debtor under any bankruptcy, reorganization, arrangement, insolvency, readjustment of debt, dissolution or liquidation law, whether now or thereafter in effect, or

(e) if any of the proceedings set forth in subparagraph (d) above are commenced against the Debtor and the Debtor by any act indicates his approval thereof, consent thereto, or acquiescence therein, or any such proceedings against the Debtor are not dismissed within 30 days after the commencement thereof then, in any of such events, this Note shall become immediately due and payable. In such event, Debtor hereby authorizes Holder to deduct the balance of the Note (including interest) from any amounts that Debtor would otherwise be obligated to pay to Debtor as a result of, or in any way in connection with, the employment relationship between them. This right of Holder shall continue beyond the termination of Debtor’s employment for any reason.

Prepayment. Debtor may prepay this Note in full at any time or in part from time to time without premium or penalty.

Payment of Costs. In addition to the principal and interest amounts specified above, the Debtor shall pay to Holder, upon demand, all costs and expenses, including reasonable attorney’s fees and legal expenses, which may be incurred by Holder in the enforcement of this Note, whether or not suit is brought herein to enforce payment.

Governing Law. This note shall be governed by the laws of the State of ___________________.

Miscellaneous. Any failure of Holder to exercise any right hereunder shall not be construed as a waiver of a right to exercise the same or any other right at any other time.

Debtor:

________________________________________ (SEAL)

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