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Request Short-Term Small Payments

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Request Short-Term Small Payments

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									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 $______ per month right now and expect to resume making the full monthly payment when the
following occurs:
_________________________________________________________________________


Please accept the reduced payments until then. If necessary, add the unpaid amount to the end of the loan or
account period and extend it by a few months.


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


Sincerely,

________________________________________
              Your signature

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

								
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