Legal Forms
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Request For Payment
REQUEST FOR PAYMENT
Date: [Date of letter]
To: [First name of debtor] [Last name of debtor]
[Company of debtor]
[Address of debtor]
[City of debtor], [State of debtor]
[Zip Code of debtor]
Dear [Mr./Mrs.] [Last name of debtor]:
In reference to the order placed on [date of order], we have received and fulfilled your request. Payment on your order is now due and payable. Please send your payment in the form of check, money order, VISA, or Mastercard. Please include your [Account/invoice] number with your payment. The total amount due is $[ Amount due] dollars. Thank you for your business, and your prompt attention to this matter.
Accounting Department
Account number: [Account number]
Invoice Number: [Invoice Number]
Amount Due: [Amount Due]
Amount of payment: [Amount of payment]
Form of payment: Check, Money Order, Visa, Master Card (circle one)
Credit Card Acct. No. __________________ Exp. Date: _____________