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S U B S C R I B E

Assignment Of Accounts Receivable [With Non-Recourse]

S A M P L E

[Date]

[Address]


FOR VALUE RECEIVED, the undersigned hereby sells and 
transfers all right, title and interest in and to the account(s) 
receivable as annexed; to [name of collection agency]. 

The undersigned warrants that the said account(s) are just and 
due and the undersigned has not received payment for same or 
any part thereof; provided, however, that said account(s) are 
sold without recourse to the undersigned in the event of non-payment.


Signed under seal this [date] day of [month, year]. 


________________________________________
(clearly print name after signature)

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