Debt Collections Letter Template – Sample

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Updated December 06, 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.

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
  • A statement informing the debtor that if they do not dispute the validity of the debt within 30 days, 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

Related Forms

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