Request for Instructions on Deferred Collections

Account Name:

Street:

City:

State, Zip:
May we please have your latest instructions on this

account? We ask this because collection has been

deferred at your request.
Please let us know if any payments have been made

so that we can update our files accordingly. If there

have been no payments tendered, we need to know

how you wish us to proceed in your behalf. For your

convenience, you may write your comments here:


Thank you for your cooperation.