DRAFT - GENERAL FORM

$________________________ (date)

To: ___________________ (drawee)

___________________ (address)

__________________ (At sight, or __________ (__________) days after sight, or __________ (__________) days after date, or on ____________ (date), or on demand) pay __________________ (to the order of __________, or to __________ or order, or to bearer, or to __________________ or bearer) __________ Dollars ($__________), and charge the sum paid to the account of __________________ (drawer).

______________________________

(Signature of Drawer)