Know all men by these presents: That I, A. B., of ---------, am held and firmly bound unto C. D., of ---------, or order (or, "or bearer") in the sum of

[here insert the penal sum, usually double the amount actually to be paid)

--------- dollars ($---------), to be paid to the said C. D. or order (or, "or bearer") for which payment well and truly to be made, I do bind myself firmly by these presents.

Dated at---------, this ---------day of ---------, 19-.

The condition of this obligation is such, that if the said A. B. shall well and truly pay, or cause to be paid, unto the said C. D. or order (or, "bearer") the sum of [here insert the amount actually to be paid] --------- dollars ($---------) with interest at the rate of--------- per cent. per annum, on the --------- day of

--, 19-, then this obligation to be void; otherwise to remain in full force and effect.

In witness whereof, etc