This contract made this ________ day of _________________, 20______
By and between:
and:
Scott Holbert
316 Watermelon Hill Rd.
Eastover, SC 29044-9321
With regard to the following recitals:
Whereas, ___________________ may have a valid claim for funds in the amount of $__________ from
the U.S. Government; and
whereas, ___________________ waives all of his/her rights of privacy and expressly authorizes
Scott Holbert to obtain payment information that has been approved and certified by the US
Government relative to his/her claim for $_________ and
whereas ___________________ has not knowingly applied for the $______________ governmental claim since / / , at any other time or through any other individual or company; and
whereas, Holbert is in the business of locating and issuing the necessary documents to the US Government for the payment of funds on behalf of a valid claimant/ and
whereas, ___________________ is desirous of having Scott Holbert process the necessary documents in (his/her/their) behalf for a fee:
BY AND BETWEEN:
AND: Scott Holbert
Signed this __________________day of_______________ 20_____..
_________________________
(Signature)
_________________________
(Telephone Number)
_________________________
(Signature)
_________________________
(Telephone Number)
_________________________
(Notary Public)
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