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Back to Forms for 'Debtor and Creditor'.





To:  _____________________ (Party Liable on Instrument)

       _____________________ (Address)




Please take notice that presentment of a _________________ (Draft), for __________

___________ ($__________) drawn by ____________________ (Drawer), of _______

______________ (Address), __________ (City), __________ (County), ____________ (State), on ______________________ (Drawee), of ____________________(Address), ______________ (City), _____________ (County), _______(State), endorsed by ______________, of __________________________ (Address), ____________ (City), _____________ (County), __________ (State), and payable on __________ (Date) to _______________________ (Payee), of __________________________ (Address), _____________ (County), _______ (State), was made on ____________ (Date).  _______________________, the undersigned of ____________________ (Address), __________ (City), __________ (County), __________ (State), who is the present holder of the ___________________ (Draft) presented the ___________ (Draft) to _________________________ (Drawee) for payment. The __________ (Draft) was dishonored when ______________________ (Drawee) refused to make payment. The undersigned looks to you for payment, including all interest, costs, and charges that have already accrued or that may accrue in the future by reason of nonpayment of this _______________ (Draft).


Dated:  _____________________



(Signature of Holder)

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