To: _________ Bank

As security for a loan made by you this date to the undersigned in the sum of $_____, borrower transfers and assigns to you all its right, title and interest in the accounts receivable listed below, and the proceeds of the accounts receivable, and any guarantees on the accounts receivable, including all monies to become due on them and all returned or repossessed goods represented by them.

Borrower certifies that the customers named below or otherwise identified by invoice or other attached documents are indebted to the borrower in the sums set forth for goods sold, shipped and delivered or services performed.

This assignment confirms all representations and warranties with respect to accounts receivable set forth in the security agreement between you and the borrower dated _________, all the terms of which are incorporated by reference, and you are entitled to all the benefits, rights and remedies provided there.

[Date]

_________[Borrower]

By: _________[Authorized signature]