1234, Main Street
Boston, MA 02123
05 April, 2005
<Recipient Address Goes Here>
Re: Bankruptcy Case No. <case number>
I understand that <business or individual name> is insolvent and has initiated bankruptcy proceedings under the above-referenced case number. As one of <his/her/their/its> creditors, I am writing to ask that I be included on the list of creditors and that <business or individual name>’s account with me be considered for payment through the bankruptcy process. As of the date of this letter, the total amount owed me by <business or individual name> is <$amount>.
I would appreciate it if you would forward to me any forms which I must submit to complete this process. Thank you for your attention to this request. I look forward to hearing from you.
encl: <List of enclosed items goes here>