OVERDUE INVOICE PAYMENT REMINDER
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Effective Date: ________________________________________________________
Place: _________________________________________________________________

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1. Parties
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This document is made on ____________________ (____________________) by:

Service Provider
Individual
Full Legal Name: _______________________________________________________
SSN / ID: ______________________________________________________________
Doc Series: ____________________________________________________________
Address: _______________________________________________________________
         _______________________________________________________________

Addressed to:

Client
Individual
Full Legal Name: _______________________________________________________
SSN / ID: ______________________________________________________________
Doc Series: ____________________________________________________________
Address: _______________________________________________________________
         _______________________________________________________________

2. SUBJECT-MATTER SCHEDULE & SPECIFICATIONS
-------------------------------------------

Invoice Number and Date: _______________________________________________
Amount Overdue: ________________________________________________________
Original Due Date: _____________________________________________________
How to Pay: ____________________________________________________________
Requested Payment Date: ________________________________________________

3. EXECUTION & SIGNATURES
-------------------------

Service Provider

Signature: _____________________________________________________________

Full Legal Name: _______________________________________________________
Date: __________________________________________________________________