Second Request For Payment Form printable pdf download

Second Request For Payment Form

Second Request for Payment

Date: ______________________________ , 20 _____

To:____________________________________________________

RE: Payment of Your Account

Dear ________________________________ :

Regarding your account, please be advised that we continue to show the following outstand-

ing balance on our books:

Invoice # __________________

Date ________________

Amount

$ __________

Invoice # __________________

Date ________________

Amount

$ __________

Interest on account at __________ percent

Amount

$ __________

Late charges

Amount

$ __________

Less credits and payments

Amount

$ __________

TOTAL BALANCE DUE

AMOUNT

$ __________

Please be advised that since our last request for payment dated

______________________________ , 20 _____ , we have still not yet received payment on

this outstanding balance. We must request that you please send the payment immediately.

Please disregard this notice if full payment has been forwarded to us.

Thank you for your immediate attention to this matter.

Very truly,

_____________________________

Signature

_____________________________

Printed Name

Second Request For Payment Form