Notice of Payment Due

Notice of Payment Due

To: From: Date: This is to inform you:

_____ Payment is past due in the amount of $______. _____ Late payment fee due in the amount of $______. _____ Late pick-up fee due in the amount of $______. _____ Returned Check in the amount of $______. _____ Returned check fee in the amount of $______.

_____ Future payments are now required in cash. _____ Services are suspended until all payments are made in full. _____ Childcare services are terminated as of __________.

Date

_____________________________

Signature of Provider

____________

Date

Notice of Payment Due

To: From: Date: This is to inform you:

_____ Payment is past due in the amount of $______. _____ Late payment fee due in the amount of $______. _____ Late pick-up fee due in the amount of $______. _____ Returned Check in the amount of $______. _____ Returned check fee in the amount of $______.

_____ Future payments are now required in cash. _____ Services are suspended until all payments are made in full. _____ Childcare services are terminated as of __________.

Date

_____________________________

Signature of Provider

____________

Date

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