R.I. Gen. Laws § 28-15-3: Standard form.

The standard form of assignment required by this chapter shall be as follows:

Know All Men and Women by These Presents;

That I, __________ in county of __________ for a valuable consideration, to me paid by __________ of __________ the receipt whereof I do hereby acknowledge, do hereby assign and transfer to said __________ all claims and demands (which I now have, and all) which within a period of ________ from the date hereof I may and shall have against my present employer and against any person whose employ I shall hereafter enter (for all sums of money due and) for all sums of money and demands which, at any time within said period, may and shall become due to me, for services as __________

To have and to hold the same to the said __________ , his or her executors, administrators and assigns, to secure a debt

(1) Of ______ dollars (with interest thereon from __________ at the rate of ____ percent per annum), for money (or goods) actually furnished by the assignee amounting to ______ dollars,

(2) Contracted prior to the execution of this assignment (or contracted simultaneously with the execution of this assignment).

In witness whereof I have set my hand this day of _________________________________________

Signed and delivered in presence of: _________________________________________