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Notice Of Withheld Delivery

Date: _

To: _ [Customer]

Reference is made to your order for certain goods under date of _, 20_.

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

__ Required payment has not been made.

__ You repudiated or withdrew your contract to buy.

__ You failed to furnish requested shipping instructions.

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

__ Other [Describe]

Very truly,

_______________________________