231 Pa. Code § 2962
The confession of judgment required by Rule 2955 shall be substantially in the following form:
[CAPTION]
Pursuant to the authority contained in the warrant of attorney, the original or a copy of which is attached to the complaint filed in this action, I appear for the defendant(s) and confess judgment in favor of the plaintiff(s) and against defendant(s) as follows:
*(Principal) *(Penal) Sum Other authorized items: | $ ___ |
_________________________ | $ ___ |
(Specify) | |
**Interest | $ ___ |
**Attorney fees | $ ___ |
*Strike out inapplicable item.
**Interest and attorney fees may be included only if authorized by the warrant.
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ATTORNEY FOR DEFENDANT(S)
231 Pa. Code § 2962