Date: ______________

Account: ____________

Name: _________________

Address: ________________________

We have sent several letters to you requesting payment on your outstanding debt. To date, we have received no response. We would be glad to arrange a payment schedule for you if you are experiencing financial difficulty. Please call us to work out payment details. Unless we receive payment, or hear from you, regarding payment arrangements by , it will be necessary for us to take further action, the cost of which you will be liable for. We hope to hear from you in order to avoid such action.

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Signature Date