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(your name)
(street)
(city, state, zip)
(date)
(name)
(street)
(city, state, zip)
_____________________
Dear ____ (name):
You did not reply to our first reminder that your account is overdue. Please confirm that you will be sending us a check for _____ (amount) to bring your account up-to-date.
Enclosed you will find a postage paid envelope for your convenience.
Sincerely,
(name)
(title)
(phone)