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[LETTERHEAD]

[Date]

____________________________________

____________________________________

____________________________________

Re: Demand for Payment

Dear ________________________________:

Our numerous attempts to resolve your long overdue account have not been successful. As you know, your overdue balance now equals $_________________ (which includes interest on the overdue account).

Your failure to make payment on your account may prompt us to take legal action to collect the account immediately. We are hopeful that you will act promptly and forward payment of the outstanding amounts as quickly as possible, but in no event later than_______ , 20___ . Interest will continue to accrue on this past due account. If you have any questions, please call the undersigned immediately at (___) ___________.

Sincerely,

[Company]

By: ___________________________________

Title: ___________________________________