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Assignment of Receivable
ASSIGNMENT OF RECEIVABLE
FOR VALUE RECEIVED, the undersigned hereby conveys,
transfers and assigns to ______________________ all right, title
and interest in all moneys due or that may become due from
____________________________ upon the annexed statement of
account.
The undersigned warrants (1) that no payment on the
annexed account has been made to the undersigned, by
________________________; (2) that the amount set forth in the
annexed account is due and owing from ________________; and (3)
that ___________________ is not entitled to claim an offset,
defense or counterclaim and that no valid deduction may be made
by __________________ other than that which is set out in the
annexed account, if any.
Signed under seal this _____ day of __________,
19__.
___________________________ _________________________
Witness
Form 209
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