Receipt of Title

SUGGESTED RECEIPT FORM

Midwest Acceptance Corp

COPY

OF

TITLE

HERE

ACKNOWLEDGEMENT

I (WE) have received the above title from ________________ on _________

                                                                       (Dealer)                        (Date)

__________________________                                ______________________

                  (Buyer)                                                                   (Co-Buyer)

__________________________                                ______________________

                 (Co-Buyer)                                                             (Co-Buyer)