NOTICE DELINQUENT ACCOUNT TURNED OVER TO COLLECTION Date: To: By letters dated __________,20__ and _________,20__ we have requested payment of $_____________ in satisfaction of your long debt. However, we have not received any response to our requests. If you are experiencing a problem in paying the $_________, we would be very happy to attempt to work out a payment schedule with you. But unless you respond to our letters, we can not assist you. Therefore, unless payment in full in the amount of $________ or a payment proposal acceptable to us is received in the next _____ (_) days, we will have no choice but to refer this account to collection. I sincerely hope that this step can be avoided, especially because you will incur the additional costs of collection. Very truly yours, _______________________________ Form 115