Date: ________________

To: _____________________

The undersigned is the holder of the below described ____________ (check) to which you are an endorser.

Notice is hereby provided that said instrument has not been paid, and protest and demand is hereby made upon you to immediately pay the face amount of the instrument in the amount of _________________ (amount).

If the event payment is not made within ____________ (no. of days) the undersigned shall proceed to suit on your warranties of endorsement.

Very truly,

______________________________