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MERCHANTS
FINANCIAL GUARDIAN, INC.

A PROFESSIONAL COLLECTION CORPORATION

(VIA FAX)

COMPLETE AND MAIL OR FAX BOTH PAGES TO: (keep a copy for your records)

MERCHANTS
FINANCIAL GUARDIAN, INC.

1215 W. IMPERIAL HIGHWAY, #105

P.O. BOX 248

BREA, CA 92822-0248

PHONE: (714) 680-8345 FAX: (714) 870-0352

(please check one)

[ ] IMMEDIATE CLAIM PLACEMENT

[ ] 10 DAY FREE DEMAND

PLEASE PROCEED WITH IMMEDIATE COLLECTION ON THE
ACCOUNT LISTED. WE AGREE TO NOTIFY YOU

PROMPTLY OF ANY PAYMENTS RECEIVED. WE HAVE READ AND AGREE TO ABIDE BY THE TERMS & CONDITIONS ON PAGE 2 OF THIS ASSIGNMENT FORM.

DEBTOR..............................................................................................................................................................................................

ADDRESS...........................................................................................................................................................................................

CITY........................................................................................................................STATE/ZIP.......................................................

NAME OF CONTACT
....................................................................................................................................................................

TELEPHONE
(........).............................................................................................CUSTOMER.......................................................

BALANCE DUE
$................................................................................DATE OF
LAST CHARGE..............................................

DEBTOR ENTITY: _______CORPORATION _______PARTNERSHIP _______INDIVIDUAL
_______LLC

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PLEASE ENCLOSE THE FOLLOWING:

_____INVOICES _____ITEMIZED STATEMENT _____CREDIT APPLICATION _____OTHER DOCUMENTS

COMMENTS/SUGGESTIONS......................................................................................................................................................

...........................................................................................................................................................................................................

WE APPRECIATE ANY COMMENTS YOU FEEL WOULD BE OF VALUE TO EXPEDITE THE
RECOVERY OF

THIS CLAIM.

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MERCHANTS FINANCIAL GUARDIAN, INC. IS AUTHORIZED TO FORWARD THIS CLAIM TO AN ATTORNEY

IF NECESSARY. NO LEGAL ACTION WILL BE TAKEN WITHOUT OUR PRIOR WRITTEN APPROVAL.

CREDITOR.....................................................................................................................................................................................

ADDRESS.......................................................................................................TELEPHONE
(.......).............................................

CITY...............................................................................................................STATE/ZIP............................................................

SIGNATURE..................................................................................................FAX (........)............................................................

PRINT NAME...............................................................................................................................................................................

MERCHANTS FINANCIAL
GUARDIAN, INC.

A PROFESSIONAL COLLECTION CORPORATION

TERMS & CONDITIONS

MERCHANTS FINANCIAL GUARDIAN, INC. (hereinafter referred
to as "MFG") and the CREDITOR (hereinafter referred to as "Client")
agree and intend to be bound by the following terms and conditions:

Client agrees that, once the
claim has been assigned to MFG, no other agency, person nor the client shall concurrently
pursue this claim. Should payment be made, MFG shall be entitled to collection fees as
outlined in paragraph 6.

Client agrees that, as the
agent for client, MFG is authorized to accept payments and endorse for deposit checks or
money orders received on accounts, the net proceeds of which MFG shall remit to client in
a timely fashion. MFG shall deposit all such funds into a clients trust account.

Client agrees that, if MFG is
entitled to fees as a result of payments made directly to client, MFG may deduct those
fees from subsequently received payments on the same claim or on other claims.

Accounts withdrawn or settled
directly by the client are nevertheless subject to collection fees, as outlined in
paragraph 6.

MFG shall be entitled to a
service charge of no less than 50% of the collection fee stated in paragraph 6, when a)
returned merchandise accepted by the client is considered direct settlement or b) client
refers a claim to MFG, which is subsequently demonstrated to have been paid by the debtor
prior to the referral to MFG.

Commercial Collection Rates: Charges
contingent upon collection are 25% on the first $2,000 collected and 20% in excess of
$2,000. All balances assigned under $300 are 50%. Second placements are all accounts
previously handled by other agencies or attorneys. The collection fee on these accounts is
50%. Legal action shall not be taken without clients written authorization, once
suit is filed, a 10% increase in fee will apply. If suit is recommended, there may be
additional expenses for court costs and attorney retainer. Interest collected is retained
by MFG as additional compensation. Additionally, treble damage charges on non-sufficient
fund checks assigned for collection shall be shared with client at the prevailing
commission rate.

Accounts assigned for
collection may be listed on Experian credit bureau at the sole discretion of MFG.

NO COLLECTION NO FEE

Merchants Financial Guardian, Inc.

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California Debt Collector License # 10971-99