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Notice - Agent To Receive Payment From Debtor
NOTICE - AGENT TO RECEIVE PAYMENT FROM DEBTOR
To: [Name of Debtor]
[Address of Debtor]
[City of Debtor], [State of Debtor] [Zip Code of Debtor]
This is to notify that [Name of Agent], has been authorized as my agent, to receive all checks or money that become payable to me from you. This is also to inform you that all such checks or money should be delivered to [Name of Agent], my agent.
This will remain in effect until you receive written notice of its cancellation, from me delivered to you by registered mail at the above address.
I agree to reimburse you for any loss or expense that may result due to your reliance on this authorization.
Signature Date
Signature Date