For value received, I, _______, of _________, transfer and assign to _________, of ___________, as assignee, savings account No. _______, in my name with ________, and all moneys due or to become due thereunder. I authorize ________ to pay over to assignee this sum out of moneys deposited in my name in the above-mentioned account.
I warrant that I have made no prior transfer or assignment of any part of the account assigned hereby and that the balance thereof is now at least __________ Dollars ($__).
I have delivered to assignee herewith the savings passbook issued in connection with this account, and I authorize assignee to ask for, demand, collect, and give a receipt for money in the assigned savings account, without any previous demand or notice. I agree to do whatever assignee may reasonably require to assure payment to assignee, to the extent hereby assigned, of the money in the account.
Dated _______, 20 __.