1234, Main Street
Boston, MA 02123
04 April, 2005
<Recipient Address Goes Here>
Re: Account No. <account number>
Please be advised that due to <description>, I will be unable to make this month’s regular payment of <$amount>.
I am enclosing a partial payment of <$amount> at this time as a symbol of my good faith.
I expect to be able to make a double payment next month, which should bring my account current.
I would appreciate it if you would contact me so we can work out a payment plan to bring my account current.
I anticipate being able to resume making my regular payment by <time frame>.
I would ask that you please not place any negative reports on my credit rating at this time. Thank you for your understanding and forbearance at this time. If you have any questions about this situation, please do not hesitate to contact me.
encl: <List of enclosed items goes here>
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