NOTICE OF WITHHELD1 DELIVERY

Date: _

To: _ [Customer]

Reference is made to your order for certain goods under date of _, 19_.

We are withholding2 delivery for the reason[s] checked:

__ Required payment has not been made.

__ You repudiated3 or withdrew your contract to buy.

__ You failed to furnish requested shipping4 instructions.

__ Certain goods are back ordered and shipment will be made in single lot.

__ Other [Describe] _

Very truly,