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