General Form of Schedule of Accounts Receivable
To: (Name of Secured Party)
The undersigned Debtor (Name of Debtor) confirms to you that all of the existing and
future accounts receivable of Debtor are assigned to you pursuant to the Security
Agreement of (date), between Debtor and you.
Debtor further certifies that the Schedule below constitutes a true and complete list of
the accounts receivable assigned pursuant to the aforementioned Security Agreement.
Copies of invoices together with evidence of shipment, delivery or performance are
attached hereto and made a part hereof.
(This is a sample).
Date of Invoice No. Debtor Address Amount