Bad Check Form

(simply copy this text and paste it into your favorite word processing program)

TO: Customer Name______________________________________________

Address_______________________________________________________

_______________________________________________________

Dear Customer: Your bank has refused to honor your check described below. We know that it is easy to lose track of account balances, and we also know that you would like to honor your check. Vermont law allows you to pay us the amount of the check within 30 days from the date of this notice. We appreciate your business and look forward to seeing you again soon.

You are hereby notified that your check made payable to _________________________

dated____________20___for $__________was presented to the bank for payment and

has been returned to us unpaid. Please pay us the amount of this check plus

mailing costs of _________, for a TOTAL DUE of $___________, within 30 days.

STORE:_____________________________________DATE MAILED:______________

ADDRESS:___________________________________PHONE:___________________

TOWN:__________________________STATE:_______________

CONTACT PERSON:______________________________

INSTRUCTIONS TO RETAILER: Place returned check in this space for copying (KEEP ORIGINAL CHECK) and make a copy of the form with the check inserted. On the copy, fill out the form and make two copies of the completed form (so you have 3 completed forms). Keep one copy for your records, send one copy to the customer via regular first class mail. Reuse this form or print it from www.vtretailers.com.

If you fail to honor your check after receiving proper notice, you will be responsible for the check amount plus mail costs, court costs, service costs, interest, attorney fees and damages of $50.00.

(July 1, 2005 Revised)