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 __________, 20__. ___________________________ _________________________ Witness Form 209