[NOTE: The following sample questionnaire is used with the New York Security Agreements Library. If you ordered the library for some other jurisdiction, some of the questions and terms would be different.]

SECURITY AGREEMENTS QUESTIONNAIRE

Identify Debtor:
Name(s):

Address(es):


Phone:
__male __female __corporation __partnership __LLC
Identify Secured Party:
Name(s):

Address(es):


Phone:
__male __female __corporation __partnership __LLC
You represent: __Debtor __Secured Party

If the other party is represented by an attorney:
Name:
Firm:

Address:


Phone:
Date of Security Agreement:

The collateral: [you can describe it on an exhibit]



__collateral is to remain in Debtor's possession
__sale of any collateral is to be a default
__encumbrance of collateral is to be a default
__Debtor must maintain hazard insurance
__prepare a short form of Security Agreement

__Security Agreement secures a Guaranty - identify the Guaranty and any Note



__Security Agreement secures a Note -
Date of Note:
Maturity Date:
Original Principal Amount - $
Interest: ___% per annum
__float with prime (__above/__at/__below) - bank:
__360 day basis for computing interest
__rate changes on specific dates:
Periodic Payments: $
per __month/ __quarter/ __semi-annual/ __annual
vs __due on demand
__due on maturity date
Do you want the following provisions -
__non-recourse
__expressly prepayable without penalty
__a prepayment premium: ___% of principal
__higher rate of interest after default: ___%
__a fixed late charge: ___% of amount due
__due on sale
__payment of attorneys' fees if foreclosed:

NOTE: Prepare the UCC-1 Financing Statements.