Date: ______________________

VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED NUMBER:
XXXXXXXXX
1RE: Returned check number __ in the amount of $_____
IMPORTANT NOTICE PURSUANT TO CIVIL CODE SECTION 1719
NAME OF PERSON WHO WROTE BAD CHECK
ADDRESS OF PERSON WHO WROTE BAD CHECK
YOUR NAME is the payee of a check number ___ you wrote for $______. The check
was not paid because it was returned for STATE REASON SUCH AS CLOSED
ACCOUNT, NON-SUFFICIENT FUNDS, STOPPED PAYMENT, ETC. and the
payee hereby demands payment pursuant to the provisions of Civil Code section 1719.
You may have a good faith dispute as to whether you owe the full amount. If you do not
have a good faith dispute with the payee and fail to pay the payee the full amount of the
check in cash, a service charge of an amount not to exceed twenty-five dollars ($25) for
the first check passed on insufficient funds and an amount not to exceed thirty-five
dollars ($35) for each subsequent check passed on insufficient funds, and the costs to
mail this notice within 30 days after this notice was mailed, you could be sued and held
responsible to pay at least both of the following:
(1) The amount of the check.
(2) Damages of at least one hundred dollars ($100) or, if higher, three times the amount
of the check up to one thousand five hundred dollars ($1,500).
If the court determines that you do have a good faith dispute with the payee, you will not
have to pay the service charge, treble damages, or mailing cost. If you stopped payment
because you have a good faith dispute with the payee, you should try to work out your
dispute with the payee. You can contact the payee at:
YOUR NAME
YOUR ADDRESS
YOUR TELEPHONE NUMBER
You may wish to contact a lawyer to discuss your legal rights and responsibilities.
_____________________________

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sent by Certified Mail, Return Receipt Requested. You must
wait until at least 30 days have passed before you can file any
legal action based on this letter. Read Civil Code Section 1719
for more details. You can search for and read the full text of
any California code sections at the link shown below.
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