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Fill and Sign the General Law Part I Title Xv Chapter 93 Section 40a Form

Fill and Sign the General Law Part I Title Xv Chapter 93 Section 40a Form

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DEMAND FOR PAYMENT OF DISHONORED CHECK DATE: _____________________TO: _____________________NAME OF MAKER: __________________________________________WARNING: YOU MAY BE SUED IF YOU DO NOT MAKE PAYMENT OF THE AMOUNT SHOWN ON THIS NOTICE WITHIN 35 DAYS AFTER THE DATE THIS NOTICE WAS MAILED.LAST KNOWN RESIDENCE ADDRESS OR PLACE OF BUSINESS _______________________________________________________________OUR CHECK/DRAFT/ORDER IN THE AMOUNT OF $ ________________ DATED _____________________, PAYABLE TO THE ORDER OF ____________________________ HAS BEEN DISHONORED BY THE BANK OR OTHER DEPOSITORY UPON WHICH IT HAS BEEN DRAWN BECAUSE:_____________________ THE MAKER HAD NO ACCOUNT WITH SUCH BANK OR DEPOSITORY_____________________ THE MAKER HAD INSUFFICIENT FUNDS ON DEPOSIT WITH SUCH BANK OR DEPOSITORYIF YOU DO NOT MAKE PAYMENT WITHIN 35 DAYS AFTER THE DATE THIS NOTICE WAS MAILED, YOU MAY BE SUED TO RECOVER PAYMENT. IF A JUDGMENT IS RENDERED AGAINST YOU IN COURT, IT WILL INCLUDE NOT ONLY THE ORIGINAL FACE AMOUNT OF THE CHECK/DRAFT/ORDER, BUT ALSO ADDITIONAL LIQUIDATED DAMAGES OF NOT LESS THAN ONE HUNDRED DOLLARS ($100) NOR MORE THAN THE FACE AMOUNT OF THE CHECK/DRAFT/ORDER PLUS FIVE HUNDRED DOLLARS ($500).PLEASE MAKE PAYMENT IN THE AMOUNT OF $ _____________________ TO:______________________________________ NAME OF PAYEE ______________________________________ ____________________________________________________________________________ADDRESS TO WHICH PAYMENT SHOULD BE DELIVERED NJ-02264

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