Know all men by these presents, That for value received, we have bargained, sold, transferred, assigned, and set over and by these presents do bargain, sell, transfer, assign and set over unto........, its successors and assigns, the claim and account set forth on the reverse side hereof, and all right, title and interest therein, and in and to any and all of the merchandise, the sale of which created said account, to have and to hold the said claim or account and any and all merchandise returned or unaccepted thereon, unto said
........, its successors and assigns, for their own use and benefit forever.
We hereby constitute and appoint said........our true and lawful attorney irrevocable in our name or otherwise but to their own use and benefit to sell, transfer, assign, set over, compromise, pledge, discharge and collect the whole or any part of said claim, or account, and to receive all moneys due or to grow due thereon and to take, hold, transfer, assign, set over, or sell and receive the proceeds of, the whole or any part of said returned merchandise and for said purposes to do all acts and things necessary or proper in the premises, and one or more persons to substitute with like power, hereby ratifying and confirming all that our said attorney or attorneys, or his or their substitute or substitutes shall lawfully do by virtue hereof.
We hereby certify and covenant that the said claim or account is a true and correct statement of a bona fide indebtedness incurred by the debtor therein named, upon the terms therein stated, now outstanding and owing to the full amount thereof for said merchandise actually sold and delivered and accepted by said debtor; that no payment has been made thereon, and that there are no defenses, offsets or counterclaims thereto; that said merchandise was, at the time of said sale, owned by us in our own right and free from any lien or encumbrance, and that said claim or account is free from all encumbrance except such as is held by said........under this instrument.
Dated, New York,.....19..