NAME OF COMMUNITY BANK _____________________________________________

LOCATION ___________________________________________________

No. OF MEMBERS______________________ CYCLE__________
DATE _________________ TERMS __________

LOAN AMOUNT ________________________

INTEREST AMOUNT FOR CYCLE ________________________

LOAN BALANCE _________________________

BIMONTHLY PAYMENT______________________________

DATE OF FIRST PAYMENT______________________________

DATE OF LAST PAYMENT ______________________________

PLEASE MAKE DEPOSITS IN ACCOUNT No. _____________________
BANK NAME ________________________________

NAME OF THE PERSON MAKING THE DEPOSIT _____________________________________________