NOTICE OF WITHHELD DELIVERY

Date： _

To： _ [Customer]

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

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，