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4150.BLD
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1993-01-06
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2KB
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126 lines
#4150
@001 Please enter the name of the Secured Party:
@415 Please enter 1st line, address of Secured Party:
@416 Please enter the 2nd line of address of Secured Party:
@417 Please enter the City, State, Zip Code of Secured Party:
@418 Please enter the name of officer or department:
@002 Please enter the name of the Debtor:
@419 Please enter 1st line, address of Debtor:
@420 Please enter the 2nd line of address of Debtor:
@421 Please enter the City, State, Zip Code of Debtor:
@423 Please enter the name of the officer or department:
@424 Please enter the date for which a statement is requested:
#4151 Is statement of account balance requested?
#4152 Is statement of collateral requested?
#4153
#4154
#end control section
#4150
/* Para. 4150: Secured party statement, Request */
REQUEST FOR STATEMENT OF ACCOUNT, LIST OF COLLATERAL
TO: @001
@415
@416
@417
Attention: @418
FROM: @002
@419
@420
@421
Attention: @423
Dated: ___________________________
Pursuant to Section 9-208 of the Uniform Security Code, @002, as
debtor, requests that the Secured Party, @001, provide:
#4151
/* Para. 4151: Statement of account, collateral */
A statement of account, indicating the aggregate amount of unpaid
indebtedness as of @424.
#4152
/* Para. 4152: Statement of collateral */
Approval of the following statement of collateral as constituting
a correct statement of the collateral claimed by Secured Party:
as of @424
See Exhibit "1" to this form
#4153
/* Para. 4153: Approval form*/
The statement above is (check one):
________________ Accepted as correct
_______________ Incorrect, our corrections or response are
attached hereto
Dated: ____________________________________
@002, by:
___________________________________________________
An Authorized Officer
Title: ___________________________________________
#4154
/* Para. 4154: Signature of the debtor */
@001 by:
__________________________________________________
An Authorized Officer
Title: _____________________________________