Date: ____________________

_______________________________
_______________________________
_______________________________

Attn: Customer Service
Name(s) on account: ____________________
Account number: ____________________

To Whom It May Concern:

At the present, I cannot pay the monthly amount required under the agreement for the following reason(s):
______________________________________________________________________

I can pay $________ per month right now and expect to resume making the full monthly payment when the following occurs:
______________________________________________________________________

Please accept the reduced payments until then. If necessary, add the unpaid amount to the end of the loan or account period and extend it by a few months.

Thank you for your understanding and help. Please write within 20 days to let me know if this is acceptable.

Sincerely,

________________________________________
		Your signature

Name:	____________________
Address:	____________________
____________________
Home phone:	____________________
Email address:	____________________