Debt Collections Letter Template – Sample

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Updated April 20, 2022

A Debt Collections Letter is a notice that is sent by a creditor seeking payment for an outstanding amount with instructions to the debtor.

Laws – 15 U.S. Code § 1692g

Table of Contents

What to Include?

In order to be compliant with Fair Debt Collection Practices the letter must contain the following:

  • The debt amount ($);
  • The creditor’s name; and
  • A statement informing the debtor that if they do not dispute the validity of the debt within 30 days that it will be assumed to be valid by the debtor.




Johnny Appleseed’s Dental Office
123 Apple Way
Appleville, CA

Date: June 1, 2017

RE: Dentist Appt. Collection

Dear Charles Smith,


Despite our previous reminders, the above amount due remains unpaid. As such, we would appreciate you making this payment as soon as possible.

AMOUNT DUE: $340.15

PLEASE REMIT PAYMENT TO: 123 Apple Way Appleville, CA 92307

We regret to advise that unless payment is received by July 1, 2017 this collection will be passed over to our debt collection agency/lawyer. This could seriously affect your credit rating and therefore urge you contact us immediately to make payment or arrange an alternative before this date.

You have the right to dispute this debt by submitting written notice within thirty (30) days of receiving this letter. If this letter is not disputed within the thirty (30) day time-frame then the collection will be considered accepted by the debtor.

Dr. Johnny Appleseed

(Video) What is a Debt Collection Letter?

How to Write

1 – The Template For This Letter Is Available Here

The files provided through any of the buttons (Adobe PDF, Open Document Text (.odt), or Microsoft Word (.docx)) under the preview picture will deliver access to the required Template Letter. This letter will contain the wording required to inform a Recipient of a debt that must be attended to but will need some information input. You may enter such information directly onscreen with the appropriate editing program or print a copy to fill it out manually.

2 – Supply The Header With Some Standard Items

Before satisfying any of the requirements in the body of the letter, the Sender should report his or her Full Name and Mailing Address using the three blank lines near the top left-hand corner of the page.

Directly below the Sender’s Mailing Address, record the Current Date.

Locate the Greeting area, then enter the Name of the Recipient on the blank line after the word “Dear.”

3 – State The Facts Specific To The Situation

To begin, find the labeled line “Due Amount” in the body of this letter. Use this area to record the exact Dollar Amount the Recipient owes and must pay.

On the next empty line, labeled “Please Remit Payment To,” document the Name and Address where the Recipient must submit the Payment Owed.

Finally, on the two blank lines following the phrase “…Unless Payment Is Received By,” record the last Calendar Date the Recipient will be allowed to Pay the Debt without further action or fees imposed by the Sender. This Date should be presented as a Month Name and Calendar Day on the blank line before the number “20” and the two-digit Calendar Year on the blank line after this number.

4 – Finalize This Document With A Valid Signature Of Intent

The Sender of this letter or Creditor must sign this letter below the word “Sincerely”

Related Forms

Past Due Invoice Letter – For individuals and businesses that have not paid an invoice for a product or service that was provided.