Fill and Sign the Affidavit Account Form

IN THE CIRCUIT COURT OF       COUNTY, MISSISSIPPI       PLAINTIFF VS. CAUSE NO.             DEFENDANT AFFIDAVIT OF AMOUNT DUE ON OPEN ACCOUNT STATE OF MISSISSIPPI COUNTY OF       PERSONALLY CAME AND APPEARED BEFORE the undersigned authority in and for said county and state,       who, being by me first duly sworn, stated upon his oath the following: 1. I am       of       , Mississippi. I am more than       years of age and suffer from no legal or mental disability. 2. I am the owner of       , a sole proprietorship with its principal place of business in       ,       County, Mississippi. I have personal knowledge of the facts set forth in this Affidavit. 3. Defendant in the above styled and numbered cause,       , agreed and contracted to pay for materials and services rendered to Defendant on credit. Said       is justly indebted to       in the principal sum of $       , which represents reasonable compensation for the services rendered, as evidenced by the statement of account and the invoices attached hereto and incorporated herein by reference. 4. The attached statement of account is true, just, accurate and correct as stated, no part of same has been paid, the same is currently due and owing from said       , said account is not usurious, nor is it subject to any setoff, and said       has not paid and has failed and refused to pay said account. 5. Plaintiff has made written demand upon Defendant       to pay the amount owed as specified and itemized in the statement of account and the invoices attached hereto, but Defendant has failed or refused to pay the same within       (       ) days. Respectfully submitted, _______________________________________       Attorney for       Of Counsel:                         Telephone:       MSB #       Attorney for       SWORN TO AND SUBSCRIBED BEFORE ME on this the       day of       , 20       . _________________________________ NOTARY PUBLIC My Commission Expires: