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Draft--With Reference To Sales Transaction

__________________ (Name of buyer)

No. __________________

$__________ __________________ (city), ______________ County,

__________________ (state), ____________ (date).

__________________ (On ____________ (date)), pay ___________ (to the order of __________________), __________ Dollars ($__________).

This draft is given in payment for ___________________ (describe item sold) pursuant to a contract dated ____________ (date).

For value received and charge the sum paid to the account of ____________________ (drawer).

_________________________________

(Signature of drawer)

To: __________________ (name)

__________________ (address)

__________________