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Account Due Your Company Your Street Your City, State& Zip Code Your Phone Customer Invoice Number Account Number Due Date Balance Finance Charge Total Due There is a balance due on your account which you may have overlooked. If you have made a payment and your check is in the mail, please accept our thanks. If you have not made a payment, please take a moment now to complete this form and return it along with your check. Thank You! Full payment enclosed Partial payment enclosed $ Payment previously mailed on Check No. Comments CUSTOMER SIGNATURE: DATE