Payment Request

Complete the form fields below to generate a payment request letter that you can print and use to help collect accounts due to your company. If the customer has the cash and is just slow in paying the account, this letter is often enough to prompt the customer to bring the account up-to-date.

Click here for a sample. All information appearing in bold type are the form fields that are either automatically completed by the program or completed based on information you supplied in this form.

Attn:	(If collecting a company debt, name of accounts payable person, if known. If collecting a personal debt, this field is required.)
Company:	(Name of company owing money)
Address:	(Debtor's street address)
City:	(Debtor's city)
State or Province:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington Washington D.C. West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick New Foundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory (Select a state or Canadian province)
Zip/Postal Code:	(Debtor's zip/postal code)
Country:	U.S.A. Canada
Account Number:	(Account number of invoice with outstanding balance)
Balance:	(Balance due on account - numbers only)
Representative:	(Your name or the name of your accounts receivable representative)
Title:	(Your title or that of your accounts receivable representative)

This is not a substitute for legal advice and it is suggested that an attorney be consulted.