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,

                                ______________________________