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Notice Of Withheld Delivery
Reference is made to your order for certain goods under date [Date].
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]
Your Name and Signature
Your Position / Title