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| Debtor Request for Certified Statement from Secured Party |
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TO: ________________________ ____________________________ ____________________________ ____________________________ Attention: __________________ FROM: ______________________ ____________________________ ____________________________ ____________________________ Attention: __________________ Dated: ___________________________ Pursuant to Section 9-208 of the Uniform Security Code, ____________________, as debtor, requests that the Secured Party, __________________________, provide: A statement of account, indicating the aggregate amount of unpaid indebtedness as of _______________________. Approval of the following statement of collateral as constituting a correct statement of the collateral claimed by Secured Party as of ______________________. See Exhibit "1" to this form. The statement above is (check one): __ Accepted as correct __ Incorrect, our corrections or response are attached hereto Dated: ____________________________________ ________________________, by: ___________________________________________________ An Authorized Officer Title: ___________________________________________ _________________________, by: __________________________________________________ An Authorized Officer Title: _____________________________________ |
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