CERTIFIED MAIL – RETURN RECEIPT REQUESTED
NAME AND ADDRESS
RE: My Client:
Check #:
Gentlemen:
Please be advised that this firm has been retained to represent ___________. As a result of my
representation, I have been asked to contact you regarding a check issued by you to ____________.
You are notified that a check numbered ______, issued by you on September __________, drawn upon
_________, and payable to __________, has been dishonored of insufficient funds. Pursuant to ___________ Law,
you have ten days from the date this notice was mailed to tender payment of the full amount of the check or
instrument plus a service charge of twenty-five dollars, the total amount being due One Hundred Twenty-two and
58/100ths ($122.58) Dollars. Unless this amount is paid in full within the specified time above, the holder of the
check or instrument may turn over the dishonored check or instrument and all other available info