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Returned Check Notice - Template, Sample Form Online

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RE: Bounced check


Dear ________,


A check numbered ________, dated ________, drawn by you on ________ located in ________, in the amount of $________ (________), made payable to ________ has been returned. This check has returned due to insufficient funds.

You will be charged a return check fee of $________ (________). You will also be charged $________ (________) to cover the cost of mailing you this notice. The total amount you will be charged is $________ (________).

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Payment is due no later than ________.

Please forward your payment to the following address:

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Feel free to contact me at ________ or ________ if you have any questions or need additional information regarding this matter.


Best,



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Fields you complete are inserted into the document live. This template is general guidance only - not legal advice.