The undersigned
hereby acknowledges that the present balance owing to
___________________ (the "Company") by the undersigned is in the amount
of $___________________ including all accrued interest and other charges to
date.
The undersigned further acknowledges that there are no credits, equities or setoffs against this agreed account balance.
Dated this________ day of__________________, 200(x) .
______________________________________
Customer
Macrotwin Company / www.FreeBusinessForms.com