FORM 7.331. STATEMENT OF CLAIM (FOR GOODS SOLD)

(CAPTION)

STATEMENT OF CLAIM

Plaintiff, , sues defendant, , and alleges: There is now
due, owing, and unpaid from defendant to plaintiff $ with interest
since .....(date)....., for the following goods sold and delivered by plaintiff to
defendant between .....(date)....., and .....(date).....:

(list goods and prices and any credits)

WHEREFORE, plaintiff demands judgment for damages against
defendant.