Fill and Sign the Collateral Assignment Form

General Form of Assignment as Collateral for Note Assignment made this       day of       , 20       , by       , of       , hereinafter (Name of Assignor) (Street Address, City, County, State, Zip Code) called the Assignor, to       , of       , (Name of Assignee) (Street Address)       , hereinafter called the Assignee. (City, County, State, Zip Code) Assignor hereby assigns to Assignee, free and clear of any claims, liens, or other encumbrances, all of Assignor's interest in       . (Description of Chose in Action) The above assignment is made by Assignor as security for a       promissory (e.g., demand) note dated       , executed by Assignor in favor of Assignee, evidencing a loan to (Date) Assignor by Assignee in the principal amount of $       . The intent of this instrument is to transfer to Assignee the       (Type of Chose in Action) and to confer on Assignee the right in full power in Assignee's absolute discretion to dispose of the       at any time without notice to Assignor and without (Type of Chose in Action) advertisement by sale, public or private, or by auction, to be credited on the such note. Any surplus over the amount due on the note shall be paid to Assignor after deduction of sale expenses by Assignee. Witness the Signature of Assignor this the       day of       , 20       . (Signature of Assignor)       (Printed Name of Assignor) General Form of Assignment as Collateral for Note Page 1 of 1