(Today’s date)
(Your name)
(Your address)
(Your phone number)
(Your email address)

(Company name)
(www.company’s url)
(Company address)
Phone #: (Company phone)
Fax #: (Company fax)

(If company is a registered business entity in another state, insert all additional contact information.)

To Whom It May Concern: As of today (today’s date) I do not authorize (company name), nor any representative,
parent company, affiliate, or subsidiary of (company name), to withdraw any funds from the checking account under
the name of (your name), account number (your account number), located at (your bank name). Your company is in
violation of (your state) (your state’s applicable code or statute citation) laws: (Insert your state’s code or
statutes text here, with proper citations to the applicable code or statute in question. These codes or statutes
would be usury, interest rate caps, and licensing requirements.)

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Your claim that the contract that I signed is only governed by the law of the state in which your company resides
is unsubstantiated. There is specific Federal case law that refutes your claim. Your company solicited, accepted
and transacted business with a citizen of the State of (your state), thus you are subject to the laws of this state
including the (applicable term in question which would be usury, interest rate cap, or licensing requirements) laws.

“Dot Com repeatedly and consciously chose to process Pennsylvania residents’ applications and to assign them passwords.
Dot Com knew that the result of these contracts would be the transmission of electronic messages into Pennsylvania. The
transmission of these files was entirely within its control. Dot Com cannot maintain that these contracts are “fortuitous”
or “coincidental” within the meaning of World-Wide Volkswagen. When a defendant makes a conscious choice to conduct business
with the residents of a forum state, “it has clear notice that it is subject to suit there.” World-Wide Volkswagen, 444 U.S.
at 297, 100 S. Ct. at 567 Dot Com was under no obligation to sell its services to Pennsylvania residents. It freely chose to
do so, presumably in order to profit from those transactions. If a corporation determines that the risk of being subject to
personal jurisdiction in a particular forum is too great, it can choose to sever its connection to the state. Id. If Dot Com
had not wanted to be amenable to jurisdiction in Pennsylvania, the solution would have been simple–it could have chosen not
to sell its services to Pennsylvania residents.” (W. D. Pa. 1997)

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*The proceeding section is only applicable if the company in question is violating codes or statutes in the states where they
are registered business entity. If the company is not in violation of any codes or statutes in any of the states where they are a
registered business entity, you need to remove the proceeding section. I have reviewed (any and all states where the company is a
registered business entity and list whatever codes or statutes that the company is violating in these states). (Insert applicable
code or statute text that the company is violating in any and all states where the company is a registered business entity, with proper
citation of the code or statute, here.) Being that (company name) is a registered business entity in the state of (applicable state
or states); (company name) is bound to adhere to the laws of (applicable state or states) as well.

*********************************************************

In lieu of your blatant disregard for the laws of the State of (your state), *the proceeding section is only applicable
if the company in question is violating codes or statutes in the states where they are registered business entity. If the
company is not in violation of any codes or statutes in any of the states where they are a registered business entity, you
need to remove the proceeding section (any applicable state the company is a registered business entity), I am offering
(company name) the opportunity to settle with me, per (your state), (your state’s code or statute number). (Insert your
state’s remedy for usurious loans, or operating without a license, or any other applicable laws here.) *The proceeding
section is only applicable if the company in question is violating codes or statutes in the states where they are registered
business entity. If the company is not in violation of any codes or statutes in any of the states where they are a registered
business entity, you need to remove the proceeding section. (If a state or states, that the company is a registered business
entity, has a good remedy for usurious loans or lack of licensing you can enter this code or statute as well.) *The proceeding
paragraph can vary depending on your state’s remedy for usurious loans or a company’s lack of a valid license within your state.
You may also be able to use the state or states where the company is a registered business entity, remedy for violating their laws.
The proceeding paragraph is written for the purpose of having your account marked paid in full, regardless of how much or how
little you have already paid, which certain states may allow. Depending on your state you may have to pay any principal that is
outstanding if you have not already paid enough interest to cover the principal. If you have paid above and beyond the principal,
some state laws entitle you to a refund of the interest, and sometimes up to two times the interest. So it is very important for you
to review your state’s remedy on usurious loans prior to writing the proceeding paragraph. I have paid you a total of ($XXX.XX)
in interest and fees, and ($XXX.XX) in principal, on a ($XXX.X) loan. Thus, I am expecting (company name) to mark the account
under the name of (your name) ‘paid in full’. At no time will (company name), any representative, parent company, subsidiary,
or affiliate of (company name), place any derogatory mark on my credit report with any credit bureau, nor any other check writing
database, such as Teletrack or an equivalent database. If (company name) does not abide to the settlement conditions stated above,
I will have no choice but to file a civil suit against (company name) for the monetary damages that I am entitled to per (your state),
*the proceeding section is only applicable if the company in question is violating codes or statutes in the states where they are
registered business entity. If the company is not in violation of any codes or statutes in any of the states where they are a registered
business entity, you need to remove the proceeding section (state or states where the company is in violation of laws and is a registered
business entity), and all legal fees that I acquire during the course of such a civil suit. I will also formally complain to, and request
that the Attorney General of (your state), (your state’s Attorney General’s name), file criminal charges against (company name)
for its illegal lending practices to the consumers within the State of (your state). *the proceeding section is only applicable if the
company in question is violating codes or statutes in the states where they are registered business entity. If the company is not in
violation of any codes or statutes in any of the states where they are a registered business entity, you need to remove the
proceeding section (If any other state where the company is a registered business entity, Attorney General’s or Division of
Financial Institutions need to be notified insert these here.) All correspondence as of today (today’s date), shall be in written
form either through the email address, (your email address) I provided to you at the time of the application, or via The United
States Postal Service. Please acknowledge receipt of this letter, and acknowledge acceptance of, and willingness to adhere to the
settlement described above, in writing, within 24 hours of receipt. If I do not receive this acknowledgement within 24 hours, I v will begin the legal proceedings described above.

Sincerely,

(Don’t forget to sign)

(Your name)

cc: (Your bank name)