• ••••••••••• 19 • • • •

To................

I, ......, do hereby authorize and appoint yon as my agent to procure for me a loan of...... dollars, to be secured by a mortgage on my real estate, which I own in fee simple, and which is described as follows, to-wit: (here insert description contained in the deed), and agree to furnish to the lender, or his attorney, an abstract of title, showing the title to be clear and unincumbered (if incumbered, state to whom, the amount of the mortgage, and the book and page where recorded), and promise to execute and deliver a mortgage, with release of dower, to secure the payment of the aforesaid sum, which shall be made payable in-----years from date, and to bear interest at not to exceed

......per cent. per annum.

I further agree that on procuring the said loan I will pay to you a commission of......per cent. on the amount of the loan.

Your agency to be exclusive, and to continue until......, 19..., and thereafter until written notice from me withdrawing same.

...............................

................, 19.....

......hereby accept this agency on the terms stated.

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