FOR VALUE RECEIVED, the undersigned hereby sells and transfers all right, title and interest in and to the account receivable as annexed; to ___________ (name).
___________ (name), the undersigned warrants that said account is just and due and the undersigned has not received payment for the same or any part thereof.
It is further provided that if any said account does not make full payment within ____________ days, the said account may be re transferred to the undersigned and the undersigned shall repurchase same for the balance then owing on said account.
Signed under seal this _____________ day of ___________ , 19____.

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