Request Long-Term Small Payments

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Request Long-Term Small Payments Powered By Docstoc
					Date: ______________


Attn: Customer Service

Name(s) on account: ____________________

Account number: _______________________

Date loan/account opened: _______________

Total amount due: ______________________

Monthly payment amount: ________________

To Whom It May Concern:

At the present, I cannot pay the monthly amount required under the agreement for the following reason(s):

I can pay you only $______ per month for the indefinite future. Please accept the reduced payments. I
promise to inform you immediately if my financial situation improves and I am able to resume making
normal payments.

Thank you for your understanding and help. Please write within 20 days to let me know if this is


              Your signature

Name:              ____________________
Address:           ____________________
Home phone:        ____________________
Email address:     ____________________

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