__________
__________ , __________ __________

__________
__________
__________ , __________

__________

Dear __________ ,

As of the above date, you still owe $__________ . Your payment is past due by __________ days. Your original due date was __________ .

If you have any questions please contact me via postal mail, phone, e-mail, at the contact information listed below. If you do not provide payment within __________ days of receiving this letter, We may pursue further legal action.

Sincerely,

__________
__________ , __________ __________
__________
__________