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Resource Location Services
123 Second Avenue
OurCity, St 02468
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This agreement is between myself, Mrs. Jane Smith of 123 Main Street, City, St. 12345 and Resource Location Services, 123 Second Avenue, OurCity, St 02468.
I agree to allow Resource Location Services to act as my agent in the collection of certain assets in which I may have an interest. These assets are identified by Resource Location Services as "Account 012345".
Upon receipt of this signed agreement, Resource Location Services will complete their research on this claim, inform me of the nature of the claim, and proceed to collect the assets that may be due me.
In consideration for their work in researching and collecting this asset, I do hereby assign to Resource Location Services an amount equal to twenty percent
(20%) of the gross amount of the claim.
Assets collected by Resource Location Services under this claim will be deposited in their agency account. Within 7 days of the payee's check clearing, Resource Location Services will send me a check for the net amount due me.
I will be responsible for no other costs related to the collection of this claim. I will not advance to Resource Location Services any money for efforts related to this claim. Compensation to Resource Location Services is limited to 20% of the assets recovered under this claim.
Resource Location Services is authorized to retain an attorney at no further cost to me to assist in collecting all assets due me related to this claim. No attorney's fees will be deducted from the amount due me under this contract.
If the research on the claim indicates that I have no assets due me, I will not owe Research Location Services any fee and Resource Location Services will not invoice me for their efforts.
This agreement is in full force an effect until the assets due me under this claim have been received.
Dated this 13th day of September, 2000.
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(Signature)
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(Name -- Please Print)
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(Street Address)
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(City, State ZIP)