RE: <<Pol_Company>>, <<Pol_PolNum>>   

<<Pol_EffectDate>>  -  <<Pol_ExpireDate>>

Final Audit - Amount Due: $ <<Input: Audit Amount Due>>

Dear <<PP_First>>:



The final audit premium shown above has been billed to you and not paid. We have returned the premium to <<Pol_Company>> for direct collection.


If your policy includes a proposed dividend, non-payment of premium will probably cause the dividend to be forfeited.


<<User Name>>
<<User_Notes>>, <<Agncy_Name>>
<<Agncy_Address>>, <<Agncy_City>>, <<Agncy_State>>  <<Agncy_Zip>>
Phone:<<Agncy_Phone>>  |  Fax: <<Agncy_Fax>>