1234, Main Street
Boston, MA 02123
04 April, 2005
<Recipient Address Goes Here>
Re: Account No. <account number>
I understand that the above-referenced account is <delinquent/past due>. I am writing to let you know that I have every intention of repaying this debt and would appreciate it if we could work out a payment plan which will bring this account current. Please contact me at your earliest convenience to make arrangements for a payment plan. I can be reached at <phone number>.
Thank you for your understanding and assistance in this matter.
encl: <List of enclosed items goes here>