Date (ie.

July 31, 2000)

BY FAX

Debtor Name
Debtor Address

Dear Debtor Name:

Account Number: Account Number

We enclose a statement of your account indicating that the sum of $Total Amount of
Debt (ie. $3,488.98) is past due and remains outstanding.

Kindly remit payment forthwith to our office at the address noted above. Your prompt
payment is appreciated so that your credit with our firm will not be affected.

If you foresee any difficulty with making payment promptly, please contact us at Contact
Number at your Firm so that we can discuss possible credit arrangements.

If payment of this amount has already been remitted, please disregard this notice and
accept our thanks for payment.

Sincerely,

Your Firm or Business Name

Per:
Your Name and Title (ie. John Smith, President)