$........... ••••••••••••• • , 19 • • • •

Received of......,......dollars, as a guaranty of good faith accompanying offer of......dollars, on terms as set forth in a written proposition this day made to the undersigned Real Estate Agent, for the purchase of.......

This offer is subject to owner's approval. If accepted, the above amount will apply as part of purchase price, and if refused the above amount will be refunded. If offer is accepted, and purchaser refuses to fulfil his part of said contract, the......dollars will be forfeited to the undersigned agency.

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Agents.