Date: _

To: _

Reference is made to a certain promissory note under date
of _, 19_, in the original amount of $_.
You have defaulted under said note in that the
installment due on _, 19_, in the amount of $_ has not been
paid.

Accordingly, demand is hereby made upon you for full
payment of the entire balance on said note in the amount of
$_, including accrued interest to date.

In the event the entire balance is not paid within the
next seven days, I shall refer this matter to an attorney
resulting in additional costs of collection.

Very truly,

______________________________