May 19, 2009
[Name of Recipient]
[City, State ZIP Code]
Dear [Name of Recipient]:
Re: [Bankruptcy Case No.]
I am a creditor of [Name of Business or Individual], who, I understand, has initiated bankruptcy proceedings under the above-referenced case number.
I wish to request inclusion in the list of creditors in this case, so that [Name of Business or Individual]’s account with me may be considered for payment as the bankruptcy process goes forward.
The total amount owed to me by [Name of Business or Individual] is [$___].
Please let me know what further steps, if any, I must take to ensure that my request for inclusion on the list is considered; if there are any forms to be filled out, please send them to me at the address on the letterhead above.
Thank you in advance for your assistance in this matter.