Account  #:		Date:
Customer:		Phone:
Address:
City:	State:		ZIP:

Note #	Date	Amount of Note	Payment Due Date	Amount of Payment

Total Past-Due Payments

$

  With regard to the Promissory Note(s) listed above, of which you are the Maker, you have defaulted on the installment payment(s) due as indicated.

  We are demanding payment of this past-due amount.  If payment is not received by us within ten (10) days from the date of this notice, we will seek to enforce our rights under the Promissory Note(s) for collection of the entire balance.

Sincerely,

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