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RECEIPT OF NOTE FOR COLLECTION

Date:
The undersigned received from , for collection, a note, dated
, (year), signed by a n d
payable to , for
dollars ($ ) with interest from
, at the rate of percent ( %), which note the undersigned is to
use best endeavors to collect, and to put the same in judgment at the costs of $
if not paid on presentation; to retain percent ( %) of the amount
actually collected for my services, and to pay the remainder to
, but in no wise to become responsible for costs, or to guarantee the collection of the same.
___________________________________
ZZAAAZAZ

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