For value received, I, __________(1)___________, of ________(2)___________, transfer and assign to ______(3)________, of _______(4)_____________, as assignee, savings account No. _____(5)_____, in my name with ___________(6)__________, and all moneys due or to become due thereunder. I authorize _______(7)_____________ to pay over to assignee this sum out of moneys deposited in my name in the above-mentioned account.

I warrant that I have made no prior transfer or assignment of any part of the account assigned hereby and that the balance thereof is now at least ______(8)_______ Dollars ($________).

I have delivered to assignee herewith the savings passbook issued in connection with this account, and I authorize assignee to ask for, demand, collect, and give a receipt for money in the assigned savings account, without any previous demand or notice. I agree to do whatever assignee may reasonably require to assure payment to assignee, to the extent hereby assigned, of the money in the account.

Dated __________(9)___________, 19__(10)_.

_____________(11)_____________

The information in this document is designed to provide an outline that you can follow when formulating business or personal plans. Due to the variances of many local, city, county and state laws, we recommend that you seek professional legal counseling before entering into any contract or agreement.