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Partial Delivery Of Goods Agreement

I, ________________ (name), of ________________ (address), _________ (city), _______________ County, ______________ (state), acknowledge having received and hereby accept __________ (quantity) ______________ (type of goods) as a partial delivery of a total of ______ (quantity) purchased from ________________________ (name), of ______________________________ (address), ______________________ (city), ______________ County, ________________ (state), on ____________ (date), for __________ Dollars ($__________).

(If applicable, add: The acceptance of the goods described in this instrument is not a waiver of any right of action that buyer may have for breach of warranty or any other cause.)

Dated: __________

________________________

Signature