Free UCC Financing Statement

UCC-1 FINANCING STATEMENT

A. NAME & PHONE OF CONTACT AT FILER (optional)

_________________________________________________________________
B. SEND ACKNOWLEDGMENT TO: (Name and Address)
[ ]







[ ] THE ABOVE SPACE IS FOR OFFICE USE ONLY
1. DEBTOR’S EXACT FULL LEGAL NAME – insert only one debtor name (1a or 1b)-do not abbreviate or combine names__________________________

____________________________________________________________________________________________________________________________
1a. ORGANIZATION’S NAME
OR
_____________________________________________________________________________________________________________________________
1b. INDIVIDUAL’S LAST NAME FIRST NAME MIDDLE NAME SUFFIX

_____________________________________________________________________________________________________________________________
1c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

_______________________|_____________________________________________________________________________________________________
1d. SEE INSTRUCTIONS 1e. TYPE OF ORGANIZATION 1f. JURISDICTION OF ORGANIZATION 1g. ORGANIZATIONAL ID#, if any
2. ADDITIONAL DEBTOR’S EXACT FULL LEGAL NAME – insert only one debtor name (2a or 2b) – do not abbreviate or combine names

_____________________________________________________________________________________________________________________________
2a. ORGANIZATION’S NAME
OR
_____________________________________________________________________________________________________________________________
2b. INDIVIDUAL’S LAST NAME FIRST NAME MIDDLE NAME SUFFIX

_____________________________________________________________________________________________________________________________
2c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

______________________|______________________________________________________________________________________________________
2d. SEE INSTRUCTIONS 2e. TYPE OF ORGANIZATION 2f. JURISDICTION OF ORGANIZATION 2g. ORGANIZATIONAL ID #, if any
3. SECURITY PARTY’S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P)-insert only one secured party name (3a or 3b)

_____________________________________________________________________________________________________________________________
3a. ORGANIZATION’S NAME
OR
_____________________________________________________________________________________________________________________________
3b. INDIVIDUAL’S LAST NAME FIRST NAME MIDDLE NAME SUFFIX

____________________________________________________________________________________________________________________________
3c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY
4. This FINANCING STATEMENT covers the following collateral:


All inventory of the Debtor acquired from the Secured Party or hereafter acquired from the Secured Party as well as accounts
Receivable, chattel paper, proceeds of collateral and products of collateral from the sale of such inventory. A Purchase Money
Security Interest Agreement and a Conditional Personal Guaranty have also been recorded as part of this Financing Statement.



5. ALTERNATIVE DESIGNATION (if applicable): ___LESSEE/LESSOR ___CONSIGNEE/CONSIGNOR ___BAILEE/BAILOR___SELLER/BUYER___AG LIEN ___NON-UCC FILING
6. This FINANCING STATEMENT is to be filed (for record) (or recorded) in the REAL _______ESTATE RECORDS Attach Addendum (if applicable)
7. Check to REQUEST SEARCH REPORTS(S) on Debtor(s) (ADDITIONAL FEE (optional) _______ALL DEBTORS _______DEBTOR 1 _______DEBTOR 2
8. OPTIONAL FILER REFERENCE DATA