Fill and Sign the Please Pay This Amount to Me Immediately Form

Warning Notice – page 1 NOTICE OF DEFAULT IN PAYMENT OF RENT WARNING PRIOR TO DEMAND TO PAY OR TERMINATE NON-RESIDENTIAL LEASE TO: Tenant(s): FROM: Landlord: Address of Leased Premises: This NOTICE is provided to you regarding the rental payments on the Lea sed Premises. According to my records, you have not made the rental payment for the month of ________________. This WARNING is to provide you with written information about your rental payments and consequences of your failure to pay timely. Pursuant to the lease to you, rental payments are due on the _____ day of each month. If the payment is not paid by the due date, the rental payment is not paid timely. If the rental is not paid timely, your Landlord has the right to provide you with a Notice to P ay or Lease Terminates which provides that if you do not pay within the sta ted notice period, the lease may be terminated and you must vacate the property. The amount currently due is: $ Rent for $ Late Charges $ Other $ Other $ Total (exclusive of future accruing costs Please pay this amount to me immediately. If you continue to fail t o make rental payments timely, I will have no option but to provide a formal notice to pay or terminate. Signed, this the day of , 20 . Signed: Landlord/Lessor, or authorized agent PROOF OF DELIVERY A copy of this Notice was delivered to Tenant: Warning Notice – page 2 by hand by registered/certified mail at the above address, which is: the place designated by Tenant for receipt of communications; Tenant’s last known place of residence; by posting prominently on the front door of the leased premises. Notice delivered/mailed/posted by: Sign Name Print Name In his/her capacity as: Landlord/Lessor; Manager; Agent. Notice delivered/mailed/posted on: [date]