TO:_______________________

The undersigned for the purpose of procuring and establishing
credit from time to time with you and further, to induce you
to permit the undersigned to become indebted to you on notes,
endorsements, guarantees, overdrafts or otherwise, furnishes
the following (or in lieu thereof the attached) which is the
most recent statement prepared by or for the undersigned as
being a full, true and correct statement of the financial
condition of the undersigned on the date indicated, and
agrees to notify you immediately of the extent and character
of any material change in said financial condition, and also
agrees that if the undersigned, or any endorser or guarantor
of any of the obligations of the undersigned, at any time
fails in business or becomes insolvent, or commits an act of
bankruptcy, or dies, or if a writ of attachment, garnishment,
execution or other legal process be issued against property
of the undersigned or if any assessment for taxes against the
undersigned, other than taxes on real property, is made by
the federal or state government or any department theeof, or
if any of the representations made below prove to be untrue,
or if the undersigned fails to notify you of any material
change as above agreed, or if such change occurs, or if the
business, or any interest therein, of the undersigned is sold,
then and in such case, all of the obligations of the
undersigned to you or held by you shall immediately be due
and payable, without demand or notice. This statement shall
be construed by you to be a continuing statement of the
condition of the undersigned, and a new and original statement
of all assets and liabilities upon each and every transaction
and by which the undersigned hereinafter becomes indebted to
you, until the undersigned advises in writing to the contrary.

____________________

Date:_______________ (Signature)