Date:
Account Name______________________________________________
Street ____________________________________________________
City________________ State_______________ Zip Code______________
Account Status:
Current $__________
30 days $__________
60 days $__________
90 days
or over $__________
Total Owing: __________________
Comment or agreement for payment from account:
Recommended action:
_____ Continue to extend credit
_____ Stop credit and accept payment plan
_____ Stop credit and enforce collection
____________________
Credit Department
Macrotwin Company / www.FreeBusinessForms.com