Demand Notice Form A

Notice of Dishonored Check Demand For Payment (under $4999.99) For check(s) $4999.99 or less; Class 1 Misdemeanor
Address(Required)

NOTICE OF DISHONORED CHECK

PURSUANT TO ARS § 13-1807, THE CHECK OR INSTRUMENT SHOWN OR DESCRIBED BELOW, ISSUED BY YOU HAS BEEN DISHONORED:

PURSUANT TO ARS § 13-1808, YOU HAVE 12 CALENDAR DAYS FROM THE DATE OF THIS NOTICE TO PAY OR TENDER TO THE HOLDER NAMED BELOW THE FULL AMOUNT OF THE CHECK OR INSTRUMENT, TOGETHER WITH ALL REASONABLE COSTS, AND STATUTORY FEES.

PAYMENT MUST BE IN THE FORM OF A MONEY ORDER, CASHIER'S CHECK OR CASH.

YOU ARE HEREBY NOTIFIED THAT UNLESS THIS AMOUNT IS PAID IN FULL WITHIN THE TIME SPECIFIED, THE HOLDER OF THE DISHONORED CHECK OR INSTRUMENT MAY TURN IT AND ALL OTHER AVAILABLE INFORMATION RELATING TO THIS INCIDENT OVER TO THE PIMA COUNTY ATTORNEY’S OFFICE FOR CRIMINAL PROSECUTION.

Please enter a number less than or equal to 4999.99.
Business Address:(Required)
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