[Your Name]

[Company Name]

[Street Address]

[City, ST ZIP Code]

[phone number]

[email]

[Date]

[Recipient Name]

[Title]

[Company Name]

[Street Address]

[City, ST ZIP Code]

Dear [Recipient Name]:

Your account is now seriously delinquent. We have sent you one request and still have not received your past due payment in the amount of $[amount].

Please remit $[amount] by [click to select a date], or your account will be closed, any outstanding orders will be cancelled, and this matter will be referred to a collection agency.

Please call me within the next three business days at [phone number], so that we may discuss how to resolve this quickly.

Sincerely,

[Your Name]

[Title]