Customer Amount Security
___________________________________________________________
NOTICE TO CUSTOMER REQUIRED BY FEDERAL LAW
Today， _____________， you have entered into a transaction which may result in a lien， mortgage or other security interest on your home. Federal Law provides you with the right to cancel this transaction， if you so desire， without any penalty or obligation at any time within three business days from the above date or the date on which all material disclosures required under the Truth in Lending Act have been given to you. By cancelling this transaction， any lien， mortgage or other security interest on your home resulting from this transaction is automatically void. Any downpayment or other consideration you may have tendered on entering this transaction must be refunded to you in the event you cancel. If you desire to cancel this transaction，you may do so by notifying the following party：
_____________________________________
_____________[address]_______________
by mail or telegram sent by midnight_______________________， or by any other form of written notice delivered to the above address no later than midnight______________________________.
Please acknowledge your receipt of this notice by signing the form indicated below.
ACKNOWLEDGMENT OF RECEIPT OF NOTICE
Each of the undersigned hereby acknowledges the receipt of two completed copies of the Notice of Right of Rescission.
______________________________ Date______________________
______________________________ Date______________________
[Customer's Signature]
