Bad Check Notice

You are hereby notified that a check, numbered [number], issued by you on [date], drawn upon [name of bank], and payable to , has been dishonored. Pursuant to [state] law, you have [number] days from receipt of this notice to tender payment of the full amount of such check plus a service charge of $[value] or an amount of up to [value]% of the face amount of the check, whichever is greater, the total amount due being $[value]. Unless this amount is paid in full within the time specified above, , as the holder of such check, may turn over the dishonored check and all other available information relating to the incident to the state attorney for criminal prosecution. You may be additionally liable in a civil action for triple the amount of the check, but in no case less than $[value], together with the amount of the check, a service charge, court costs, reasonable attorney fees, and incurred bank fees, as provided in §[section number of applicable law].